Active NPI
Connie Rae Sullivan, R.PH.
- Pharmacist
- Lyons, CO
National Provider Identifier
1710142146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 117137-8
- Practice address
- 7 Eagle Nest Lane
Lyons, CO 80540-1370 - Phone
- (303) 823-0406
- Fax
- (877) 471-0364
- NPI assigned
- Jul 24, 2008
- Last updated
- Jul 24, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 117137-8 | MN | Primary |
Addresses
Primary practice location
7 Eagle Nest Lane
Lyons, CO 80540-1370
Mailing address
PO Box 1370
7 Eagle Nest Lane
Lyons, CO 80540-1370
Phone (303) 823-0406
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117137-8 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216857600000",
"number": "1710142146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1370",
"address_2": "7 EAGLE NEST LANE",
"city": "LYONS",
"state": "CO",
"postal_code": "805401370",
"telephone_number": "303-823-0406",
"fax_number": "877-471-0364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 EAGLE NEST LANE",
"city": "LYONS",
"state": "CO",
"postal_code": "805401370",
"telephone_number": "303-823-0406",
"fax_number": "877-471-0364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CONNIE",
"middle_name": "RAE",
"name_prefix": "Mrs.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-24",
"last_updated": "2008-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "117137-8",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lyons, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.