Provider Demographics
NPI:1013228451
Name:HYSON, SUZANNE ROSE
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ROSE
Last Name:HYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 JASONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3524
Mailing Address - Country:US
Mailing Address - Phone:410-876-8371
Mailing Address - Fax:
Practice Address - Street 1:9708 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1108
Practice Address - Country:US
Practice Address - Phone:410-256-6400
Practice Address - Fax:410-529-4796
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD183500000X183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist