Provider Demographics
NPI:1467058610
Name:PARK, SUSAN S (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:PARK
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 1:141 FAIRFIELD CIR N
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2862
Mailing Address - Country:US
Mailing Address - Phone:215-500-1265
Mailing Address - Fax:
Practice Address - Street 1:1300 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-2351
Practice Address - Country:US
Practice Address - Phone:610-326-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist