Provider Demographics
NPI:1467032920
Name:HATHAWAY, SUSAN L (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:HATHAWAY
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 1:121 PADELFORD ST
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1203
Mailing Address - Country:US
Mailing Address - Phone:774-218-3374
Mailing Address - Fax:508-675-3202
Practice Address - Street 1:296 BUFFINTON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-4528
Practice Address - Country:US
Practice Address - Phone:508-674-0342
Practice Address - Fax:508-675-3202
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA025666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist