Provider Demographics
NPI:1215204284
Name:MIRSOIAN, SUSAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MIRSOIAN
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 1:10631 STOKES AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1236
Mailing Address - Country:US
Mailing Address - Phone:415-216-6422
Mailing Address - Fax:
Practice Address - Street 1:2141 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2708
Practice Address - Country:US
Practice Address - Phone:415-567-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH66198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist