Provider Demographics
NPI:1033106273
Name:MAYER, SUSAN D (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:MAYER
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 1:409 WILLOW WELL CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2045
Mailing Address - Country:US
Mailing Address - Phone:203-314-9748
Mailing Address - Fax:203-271-2126
Practice Address - Street 1:409 WILLOW WELL CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2045
Practice Address - Country:US
Practice Address - Phone:203-314-9748
Practice Address - Fax:203-271-2126
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist