Provider Demographics
NPI:1316538218
Name:SULESKY, JOHANNA XIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:XIA
Last Name:SULESKY
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 1:3132 CORLEAR DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8921
Mailing Address - Country:US
Mailing Address - Phone:315-481-5385
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2325
Practice Address - Country:US
Practice Address - Phone:315-458-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist