Provider Demographics
NPI:1568231777
Name:SUSI, JESUS JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:JESUS JOHN
Middle Name:
Last Name:SUSI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SUSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5000 NE 42ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4290
Mailing Address - Country:US
Mailing Address - Phone:503-935-6740
Mailing Address - Fax:
Practice Address - Street 1:18110 SE 34TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9418
Practice Address - Country:US
Practice Address - Phone:800-330-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61468281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist