Provider Demographics
NPI:1063016012
Name:TOOLE, SUSAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TOOLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COPPERFIELD DR N
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3946
Mailing Address - Country:US
Mailing Address - Phone:916-849-4105
Mailing Address - Fax:
Practice Address - Street 1:4725 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6219
Practice Address - Country:US
Practice Address - Phone:912-355-7111
Practice Address - Fax:912-354-2102
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist