Provider Demographics
NPI:1598053555
Name:ETSITTY, SUSAN F (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:ETSITTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CLAUSCHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:500 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-2169
Mailing Address - Country:US
Mailing Address - Phone:928-289-6215
Mailing Address - Fax:928-289-6293
Practice Address - Street 1:6300 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2761
Practice Address - Country:US
Practice Address - Phone:928-863-7331
Practice Address - Fax:928-635-7140
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist