Active NPI
Charles Robert Sullivan
- Pharmacist
- Coos Bay, OR
National Provider Identifier
1801190194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0012450
- Practice address
- 230 E Johnson Ave
Coos Bay, OR 97420-1478 - Phone
- (541) 267-1709
- NPI assigned
- Dec 31, 2010
- Sex
- Male
- Sole proprietor
- No
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 | 0012450 | OR | Primary |
Addresses
Primary practice location
230 E Johnson Ave
Coos Bay, OR 97420-1478
Mailing address
230 E Johnson Ave
Coos Bay, OR 97420-1478
Phone (541) 267-1709
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0012450 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293753600000",
"number": "1801190194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 E JOHNSON AVE",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974201478",
"telephone_number": "541-267-1709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 E JOHNSON AVE",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974201478",
"telephone_number": "541-267-1709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "CHARLES",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-31",
"last_updated": "2010-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "0012450",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.