Provider Demographics
NPI:1073812699
Name:RELAO, SUSANA URBANAN
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:URBANAN
Last Name:RELAO
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:HAYNESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22472-0122
Mailing Address - Country:US
Mailing Address - Phone:973-337-3480
Mailing Address - Fax:
Practice Address - Street 1:17422 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435
Practice Address - Country:US
Practice Address - Phone:804-529-6230
Practice Address - Fax:804-452-9526
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist