Provider Demographics
NPI:1659694420
Name:VISSER, SUZANNE PATRICIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:PATRICIA
Last Name:VISSER
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 1:14 EASTMOUNT DR
Mailing Address - Street 2:APT. 270
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-2158
Mailing Address - Country:US
Mailing Address - Phone:518-729-3277
Mailing Address - Fax:
Practice Address - Street 1:14 EASTMOUNT DR
Practice Address - Street 2:APT. 270
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-2158
Practice Address - Country:US
Practice Address - Phone:518-729-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist