Provider Demographics
NPI:1326097593
Name:PIERCE, SUSAN RAFTERY (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RAFTERY
Last Name:PIERCE
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 1:6180 W GOWAN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4818
Mailing Address - Country:US
Mailing Address - Phone:702-250-9767
Mailing Address - Fax:702-636-3069
Practice Address - Street 1:2455 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4325
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:702-636-3069
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist