Most Relevant Information
Provider Data
| NPI Number: | 1003411869 |
| Provider Name: | LYNETTE SULLIVAN |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 26017580A |
Most Important Dates
| Enumeration Date: | 12/01/2020 |
| Last Updated: | 12/01/2020 |
Provider Practice Location
2003 BROADWAY ST
ANDERSON
IN
460121602
Practice Location Phone/Fax
| Phone: | 7656431515 |
| Fax: |
Provider Mailing Location
2003 BROADWAY ST
ANDERSON
IN
460121602
Provider Mailing Phone/Fax
| Phone: | 7656431515 |
| Fax: |