Provider Demographics
NPI:1598190688
Name:WALPOLE, SUZANNE SHEREE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:SHEREE
Last Name:WALPOLE
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 1:3971 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12885-1152
Mailing Address - Country:US
Mailing Address - Phone:518-623-2993
Mailing Address - Fax:518-623-3169
Practice Address - Street 1:3971 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:NY
Practice Address - Zip Code:12885-1152
Practice Address - Country:US
Practice Address - Phone:518-623-2993
Practice Address - Fax:518-623-3169
Is Sole Proprietor?:No
Enumeration Date:2013-09-07
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist