Provider Demographics
NPI:1609159946
Name:DELMENDO, SUSAN MARCOS (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARCOS
Last Name:DELMENDO
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 1:1051 HUME WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5558
Mailing Address - Country:US
Mailing Address - Phone:707-453-7342
Mailing Address - Fax:707-453-7363
Practice Address - Street 1:1051 HUME WAY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5558
Practice Address - Country:US
Practice Address - Phone:707-453-7342
Practice Address - Fax:707-453-7363
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist