Active NPI
Kelly C Sullivan, PHARMD
- Pharmacist
- Amsterdam, NY
National Provider Identifier
1407064595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 048152
- Practice address
- 100 Amsterdam Commons
Amsterdam, NY 12010 - Phone
- (518) 770-7181
- Fax
- (518) 770-7181
- NPI assigned
- May 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 048152 | NY | Primary |
| Pharmacist | 183500000X | PS39975 | FL |
Addresses
Primary practice location
100 Amsterdam Commons
Amsterdam, NY 12010
Mailing address
100 Amsterdam Commons
Amsterdam, NY 12010
Phone (518) 770-7181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS39975 | FL | MD | Pharmacist |
| 048152 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267660800000",
"number": "1407064595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 AMSTERDAM COMMONS",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "12010",
"telephone_number": "518-770-7181",
"fax_number": "518-770-7181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 AMSTERDAM COMMONS",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "12010",
"telephone_number": "518-770-7181",
"fax_number": "518-770-7181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KELLY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-20",
"last_updated": "2010-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "048152",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS39975",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amsterdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.