Provider Demographics
NPI:1043758485
Name:DEROSE, SUZANNE (RPH, PHARM D)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:DEROSE
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BEECHAM DR # SR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-9791
Mailing Address - Country:US
Mailing Address - Phone:412-438-5042
Mailing Address - Fax:412-920-1869
Practice Address - Street 1:215 BEECHAM DR # SR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9791
Practice Address - Country:US
Practice Address - Phone:412-438-5042
Practice Address - Fax:412-920-1869
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044461L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist