Provider Demographics
NPI:1588641146
Name:MCCAULEY, SUSAN MARIE (PT04)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:PT04
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 25TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5218
Mailing Address - Country:US
Mailing Address - Phone:206-362-5843
Mailing Address - Fax:
Practice Address - Street 1:1820 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6803
Practice Address - Country:US
Practice Address - Phone:206-632-3314
Practice Address - Fax:206-545-8154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00061036183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician