Provider Demographics
NPI:1417280694
Name:VANDERVER, SUZANNA GRACE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SUZANNA
Middle Name:GRACE
Last Name:VANDERVER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 E HIGGINS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6889
Mailing Address - Country:US
Mailing Address - Phone:843-849-0078
Mailing Address - Fax:
Practice Address - Street 1:8571 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9208
Practice Address - Country:US
Practice Address - Phone:843-863-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-06
Last Update Date:2009-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist