Provider Demographics
NPI:1093916165
Name:MICIOLEK, SUSAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MICIOLEK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8537 BELLA SERA WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8416
Mailing Address - Country:US
Mailing Address - Phone:910-399-2338
Mailing Address - Fax:
Practice Address - Street 1:6932 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8899
Practice Address - Country:US
Practice Address - Phone:910-313-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist