Maura Sullivan, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051.301597 Issued in IL

Practice address

2404 S Perryville Rd
Rockford, IL 61108-8231

Phone

(815) 332-3256

NPI assigned

Oct 3, 2018

Last updated

Oct 3, 2018By the provider in NPPES

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": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1598230765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11211 S TALMAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606551911",
            "telephone_number": "773-208-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 S PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611088231",
            "telephone_number": "815-332-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MAURA",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-03",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.301597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDFPR",
            "identifier": "051.301597",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane Marie Sudderberg
• Addi Suleiman, M.D.
• Brittany Sullivan, D. C.
• Kathleen Sullivan
• Martha J Sullivan, CNP CERTIFIED NURSE
• Robin Sullivan, APNP
• Sean Sullivan, MS, LCPC
• Summit Radiology, LLC
• Summit Radiology, LLC
• Jeffrey Byron Sundberg, LCSW

• Pharmacist in Rockford, IL
• Providers in Rockford, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.