Provider Demographics
NPI:1003031493
Name:ANTHONY, SUZANNE NASH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:NASH
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 FINSBURY LN NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4701
Mailing Address - Country:US
Mailing Address - Phone:616-890-9692
Mailing Address - Fax:
Practice Address - Street 1:4021 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2177
Practice Address - Country:US
Practice Address - Phone:616-974-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist