Thomas S. Sullivan, M.S., R.PH., BCNSP

Primary specialty

Nutrition Support PharmacistTaxonomy code 1835N1003X

License

5302025761 Issued in MI

Practice address

21230 Dequindre Rd
Warren, MI 48091-2279

Phone

(586) 880-2483

NPI assigned

Sep 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Registered Pharmacist

State licenses

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1477547933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 BELANGER ST",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363302",
            "telephone_number": "313-378-5416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21230 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912279",
            "telephone_number": "586-880-2483"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 Kercheval Ave",
            "address_purpose": "LOCATION",
            "city": "Grosse Pointe Farms",
            "state": "MI",
            "postal_code": "482363610",
            "country_code": "US",
            "telephone_number": "313-640-2385",
            "fax_number": "313-343-8657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "THOMAS",
        "middle_name": "S.",
        "credential": "M.S., R.PH., BCNSP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302025761",
            "primary": false
        },
        {
            "code": "1835N1003X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Nutrition Support",
            "state": "MI",
            "license": "5302025761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nutrition Support Pharmacist in Warren, MI
• Providers in Warren, MI by specialty
• Nutrition Support Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; 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.