Provider Demographics
NPI:1083904296
Name:OLEVNIK, SUSAN GAYLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAYLE
Last Name:OLEVNIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9219
Mailing Address - Country:US
Mailing Address - Phone:570-585-1046
Mailing Address - Fax:
Practice Address - Street 1:113 MILLER RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9219
Practice Address - Country:US
Practice Address - Phone:570-585-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032922L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist