Provider Demographics
NPI:1083977714
Name:SZLAIUS, SUZANNE ELAINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELAINE
Last Name:SZLAIUS
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 1:1133 OLD COUNTY RD
Mailing Address - Street 2:LUCKY PHARMACY #749
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4009
Mailing Address - Country:US
Mailing Address - Phone:650-637-1788
Mailing Address - Fax:650-637-0185
Practice Address - Street 1:1133 OLD COUNTY RD
Practice Address - Street 2:LUCKY PHARMACY #749
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4009
Practice Address - Country:US
Practice Address - Phone:650-637-1788
Practice Address - Fax:650-637-0185
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50004183500000X
NC12695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50004OtherCA LICENSE #
NC12695OtherNC LICENSE #