Provider Demographics
NPI:1225425648
Name:SCHUSSMAN, CAROLYN (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SCHUSSMAN
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 1:39678 SW OAK LN
Mailing Address - Street 2:
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-9607
Mailing Address - Country:US
Mailing Address - Phone:503-559-3002
Mailing Address - Fax:
Practice Address - Street 1:2501 S AVE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7734
Practice Address - Country:US
Practice Address - Phone:928-317-6863
Practice Address - Fax:928-317-6869
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019526183500000X
ORRPH-0006608183500000X
CARPH32499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist