Active NPI
John P. Sullivan, MS, PHARMD, RPH
- Pharmacist
- Medford, MA
National Provider Identifier
1962290460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH1001193
- Practice address
- 3920 Mystic Valley Pkwy #1112
Medford, MA 02155-6911 - Phone
- (617) 620-1020
- NPI assigned
- Apr 25, 2025
- 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 | PH1001193 | MA | Primary |
Addresses
Primary practice location
3920 Mystic Valley Pkwy #1112
Medford, MA 02155-6911
Mailing address
3920 Mystic Valley Pkwy #1112
Medford, MA 02155-6911
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
- Master of Science, Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH1001193 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | 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 and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775174400000",
"number": "1962290460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 MYSTIC VALLEY PKWY #1112",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021556911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 MYSTIC VALLEY PKWY #1112",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021556911",
"telephone_number": "617-620-1020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "JOHN",
"middle_name": "P.",
"name_prefix": "Dr.",
"credential": "MS, PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-25",
"last_updated": "2026-04-03",
"certification_date": "2026-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH1001193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.