Provider Demographics
NPI:1497054555
Name:MAMULA, SUSAN MARIE (BS PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:MAMULA
Suffix:
Gender:F
Credentials:BS PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:333 ROUSER RD
Mailing Address - Street 2:BUILDING 4, SUITE 503
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2773
Mailing Address - Country:US
Mailing Address - Phone:717-691-6252
Mailing Address - Fax:866-507-4584
Practice Address - Street 1:333 ROUSER RD
Practice Address - Street 2:BUILDING 4, SUITE 503
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2773
Practice Address - Country:US
Practice Address - Phone:717-691-6252
Practice Address - Fax:866-507-4584
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039604L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist