Provider Demographics
NPI:1346505997
Name:KALANTAR, SUZAN NADIMI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:NADIMI
Last Name:KALANTAR
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 1:648 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9030
Mailing Address - Country:US
Mailing Address - Phone:919-346-6689
Mailing Address - Fax:919-346-6691
Practice Address - Street 1:648 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9030
Practice Address - Country:US
Practice Address - Phone:919-346-6689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023495272Medicaid