Provider Demographics
NPI:1598282618
Name:TADDEO, SUSAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:TADDEO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1361
Mailing Address - Country:US
Mailing Address - Phone:908-232-5882
Mailing Address - Fax:
Practice Address - Street 1:612 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1361
Practice Address - Country:US
Practice Address - Phone:908-232-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist