Provider Demographics
NPI:1578887055
Name:EBERLE, SUZANNE MARY (RPH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:EBERLE
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 1:247 CAYUGA RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1900
Mailing Address - Country:US
Mailing Address - Phone:716-565-9775
Mailing Address - Fax:716-565-9778
Practice Address - Street 1:247 CAYUGA RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1900
Practice Address - Country:US
Practice Address - Phone:716-565-9775
Practice Address - Fax:716-565-9778
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist