Provider Demographics
NPI:1124577010
Name:BUMPUS, SUZANNE MICHELE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MICHELE
Last Name:BUMPUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16856 W IRONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1303
Mailing Address - Country:US
Mailing Address - Phone:802-734-7720
Mailing Address - Fax:
Practice Address - Street 1:16856 W IRONWOOD ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-1303
Practice Address - Country:US
Practice Address - Phone:802-734-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0114309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist