Provider Demographics
NPI:1235342395
Name:CLARK, SUZANNE KOZEE (RPH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KOZEE
Last Name:CLARK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUZANNE
Other - Last Name:KOZEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7141 SW 34TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2790
Mailing Address - Country:US
Mailing Address - Phone:352-871-4897
Mailing Address - Fax:352-331-4898
Practice Address - Street 1:300 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8540
Practice Address - Country:US
Practice Address - Phone:352-379-8815
Practice Address - Fax:352-380-9777
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0025161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist