Provider Demographics
NPI:1528202405
Name:SUSLIK, DEBRA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:SUSLIK
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 1:6095 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3818
Mailing Address - Country:US
Mailing Address - Phone:757-420-7921
Mailing Address - Fax:866-204-1801
Practice Address - Street 1:6095 INDIAN RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3818
Practice Address - Country:US
Practice Address - Phone:757-420-7921
Practice Address - Fax:866-204-1801
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist