Provider Demographics
NPI:1508415225
Name:NALLIAH, SUSANNA FLORENCE I
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:FLORENCE
Last Name:NALLIAH
Suffix:I
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:IU HEALTH BALL MEMORIAL HOSPITAL INPATIENT PHARMACY
Mailing Address - Street 2:2401 W. UNIVERSITY AVE
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304
Mailing Address - Country:US
Mailing Address - Phone:765-747-3412
Mailing Address - Fax:
Practice Address - Street 1:IU HEALTH BALL MEMORIAL HOSPITAL INPATIENT PHARMACY
Practice Address - Street 2:2401 W. UNIVERSITY AVE
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-747-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021190A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist