Provider Demographics
NPI:1619252129
Name:BRISTOW, SUSAN LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-4342
Mailing Address - Country:US
Mailing Address - Phone:916-560-4002
Mailing Address - Fax:916-560-4023
Practice Address - Street 1:7000 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4342
Practice Address - Country:US
Practice Address - Phone:916-560-4002
Practice Address - Fax:916-560-4023
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist