Provider Demographics
NPI:1073058418
Name:EASTERLY, SUSAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8571 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9208
Mailing Address - Country:US
Mailing Address - Phone:843-863-9828
Mailing Address - Fax:
Practice Address - Street 1:8571 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9208
Practice Address - Country:US
Practice Address - Phone:843-863-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist