Sullivan Pharmaceuticals Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY38259 Issued in CA

Legal business name

SULLIVAN PHARMACEUTICALS INC

Doing business as

MONTCLAIR PHARMACY

Practice address

6123 La Salle Ave
Oakland, CA 94611-2801

Phone

(510) 339-9393

Fax

(510) 339-9394

NPI assigned

Feb 2, 2007

Organization subpart

No

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

Authorized official

Name

William Sullivan

Title

Pharmacist in Charge

Phone

(510) 339-9393

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MONTCLAIR PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1639217623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 LA SALLE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946112801",
            "telephone_number": "510-339-9393",
            "fax_number": "510-339-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 LA SALLE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946112801",
            "telephone_number": "510-339-9393",
            "fax_number": "510-339-9394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN PHARMACEUTICALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "510-339-9393"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY38259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0539431",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA382590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONTCLAIR PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nosakhare Kayode Sule, PHARM.D
• Maimunat Talatu Suleman, SOCIAL WORKER
• Jill Erin Sulka, PSY.D.
• Kriss Sulka, LCSW
• Rhonda Sullen
• Andrea Mary Sullivan, D.C., CCSP
• Deborah L Sullivan
• Jalen Sullivan
• Kenya Sherrod Sullivan, MSW
• Laura Lee Sullivan, M.S.CLINICALREHABSE

• Community/Retail Pharmacy in Oakland, CA
• Providers in Oakland, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; 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.