Provider Demographics
NPI:1093483802
Name:SISLIAN, SYUZANNA (RPH)
Entity Type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:SISLIAN
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 1:1806 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6631
Mailing Address - Country:US
Mailing Address - Phone:559-826-6641
Mailing Address - Fax:
Practice Address - Street 1:1806 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6631
Practice Address - Country:US
Practice Address - Phone:559-826-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist