Provider Demographics
NPI:1477142412
Name:ZACHARIAH, SUZEN (RPH)
Entity Type:Individual
Prefix:
First Name:SUZEN
Middle Name:
Last Name:ZACHARIAH
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 1:2700 TIBBETS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6900
Mailing Address - Country:US
Mailing Address - Phone:817-684-9464
Mailing Address - Fax:817-684-9287
Practice Address - Street 1:2700 TIBBETS DR STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6900
Practice Address - Country:US
Practice Address - Phone:817-684-9464
Practice Address - Fax:817-684-9287
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist