NPIMap

Individual provider Active NPI

Katlynn A Sullivan, PHARMD

  • Pharmacist
  • Hazlehurst, MS
National Provider Identifier
1861164113
Registry record updated Dec 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
E-100426 Issued in MS
Practice address
28095 Highway 28
Hazlehurst, MS 39083-2239
Phone
(601) 894-5501
Fax
(601) 894-5721
NPI assigned
Oct 4, 2021
Last updated
Dec 24, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X E-100426 MS Primary

Addresses

Primary practice location

28095 Highway 28
Hazlehurst, MS 39083-2239

Mailing address

28095 Highway 28
Hazlehurst, MS 39083-2239
Phone (601) 894-5501

Other practice location 1

1000 Hugh Ward Blvd
Flowood, MS 39232-6600
Phone (601) 992-3426

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rxm.12154@store.walgreens.com Direct

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

LicenseStateTypeSpecialty
E-100426MSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co CurrentSince Mar 6, 2022 Accepting new patients
Walgreen Co CurrentSince Dec 28, 2022 Accepting new patients
Walgreen Co PastSince Oct 1, 2021 Accepting new patients

Locations

1000 Hugh Ward Blvd
Flowood, MS 39232
Phone (601) 992-2074

28095 Highway 28
Hazlehurst, MS 39083
Phone (601) 894-5501

Interoperability endpoints

  • Direct secure messaging: rxm.12154@store.walgreens.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671840000000",
    "number": "1861164113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28095 HIGHWAY 28",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390832239",
            "telephone_number": "601-894-5501",
            "fax_number": "601-894-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28095 HIGHWAY 28",
            "city": "HAZLEHURST",
            "state": "MS",
            "postal_code": "390832239",
            "telephone_number": "601-894-5501",
            "fax_number": "601-894-5721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Hugh Ward Blvd",
            "address_purpose": "LOCATION",
            "city": "Flowood",
            "state": "MS",
            "postal_code": "392326600",
            "country_code": "US",
            "telephone_number": "601-992-3426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KATLYNN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-04",
        "last_updated": "2022-12-24",
        "certification_date": "2022-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-100426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rxm.12154@store.walgreens.com",
            "affiliation": "N",
            "endpointDescription": "store 12154 email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "28095 Highway 28",
            "city": "Hazlehurst",
            "state": "MS",
            "country_code": "US",
            "postal_code": "390832239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hazlehurst, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2022; 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.