Active NPI
Melissa Irene Sullivan, PHARMD.
- Pharmacist
- Hohenwald, TN
National Provider Identifier
1831697796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9424
- Practice address
- 612 E Main St
Hohenwald, TN 38462-2008 - Phone
- (931) 796-3284
- Fax
- (931) 796-5081
- NPI assigned
- Jan 25, 2018
- Last updated
- Jan 25, 2018
- 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 | 9424 | TN | Primary |
Addresses
Primary practice location
612 E Main St
Hohenwald, TN 38462-2008
Mailing address
612 E Main St
Hohenwald, TN 38462-2008
Phone (931) 796-3284
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9424 | Other | TN | TENNESSEE BOARD OF PHARMACY |
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9424 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Walmart Pharmacy 10-1115
- Community/Retail Pharmacy
- Hohenwald, TN
- NPI 1386661551
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516838400000",
"number": "1831697796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 E MAIN ST",
"city": "HOHENWALD",
"state": "TN",
"postal_code": "384622008",
"telephone_number": "931-796-3284",
"fax_number": "931-796-5081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 E MAIN ST",
"city": "HOHENWALD",
"state": "TN",
"postal_code": "384622008",
"telephone_number": "931-796-3284",
"fax_number": "931-796-5081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MELISSA",
"middle_name": "IRENE",
"credential": "PHARMD.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-25",
"last_updated": "2018-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "9424",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNESSEE BOARD OF PHARMACY",
"identifier": "9424",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hohenwald, TN
- Victoria Skelton
- Sleep Diagnostics Center, LLC
- State of Tennessee (Lewis County Health Department)
- Lucinda Victoria Stiles, LMFT
- Clara J Stoll, CPM-TN
- Elizabeth Thompson, BS
- Top Flight Medical Group LLC
- Miranda Ulanowski, FNP-C
- Vision Source of Lewis County LLC
- Wal-Mart Stores East LP (Walmart Pharmacy 10-1115)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.