Stacie Sullivan, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

E-010525 Issued in MS

Practice address

1625 Simpson Highway 49
Magee, MS 39111-4207

Phone

(601) 849-3228

NPI assigned

Dec 13, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607817600000",
    "number": "1467048686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "543 SIMPSON HIGHWAY 540",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391149065",
            "telephone_number": "601-919-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SIMPSON HIGHWAY 49",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391114207",
            "telephone_number": "601-849-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "STACIE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-13",
        "last_updated": "2020-12-13",
        "certification_date": "2020-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-010525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "E-010525",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wanda L Steinwinder, LCSW
• Evan J Stout, O.D.
• James H Stuard, DMD
• Jonathan Overby Styron, RPH.
• Madeline Klaire Sullivan, DPT
• The Pedz Clinic
• Thomas R. Blackledge, Jr., MD, PA
• Summer Thomas, OTR/L
• Jessica Ellen Tucker, PHARMD
• Venture Hospitalist, LLC

• Pharmacist in Magee, MS
• Providers in Magee, MS by specialty
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.