Provider Demographics
NPI:1275073272
Name:HAUF, SUSAN LESLIE
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LESLIE
Last Name:HAUF
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 1:25 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3301
Mailing Address - Country:US
Mailing Address - Phone:860-460-2449
Mailing Address - Fax:
Practice Address - Street 1:154 ELM ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROK
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-388-6461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist