Provider Demographics
NPI:1033403340
Name:VICTOR, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:VICTOR
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 1:5555 YOUNGSTOWN WARREN RD UNIT 950
Mailing Address - Street 2:T-1301
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 CROSS ST STE 100
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1026
Practice Address - Country:US
Practice Address - Phone:330-926-4945
Practice Address - Fax:330-252-9232
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist