Provider Demographics
NPI:1265034052
Name:RAFLA, SUZAN H
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:H
Last Name:RAFLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 RUTHERFORD PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-3418
Mailing Address - Country:US
Mailing Address - Phone:407-380-9724
Mailing Address - Fax:407-380-9637
Practice Address - Street 1:201 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3504
Practice Address - Country:US
Practice Address - Phone:407-380-9724
Practice Address - Fax:407-380-9637
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty