Provider Demographics
NPI:1417290016
Name:KLIPPEL, SUSAN M (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:KLIPPEL
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 1:578 AVIATION RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1814
Mailing Address - Country:US
Mailing Address - Phone:518-792-7583
Mailing Address - Fax:
Practice Address - Street 1:578 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1814
Practice Address - Country:US
Practice Address - Phone:518-792-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI038090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist