Provider Demographics
NPI:1477989234
Name:EDMONDSON, SUSAN E
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 TWIN PEAKS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1728
Mailing Address - Country:US
Mailing Address - Phone:925-451-8690
Mailing Address - Fax:
Practice Address - Street 1:2344 6TH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2412
Practice Address - Country:US
Practice Address - Phone:510-981-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician