Provider Demographics
NPI:1710268867
Name:BOOTH, SUZANNE PATRICIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PATRICIA
Last Name:BOOTH
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 1:3495 PIEDMONT RD. NE
Mailing Address - Street 2:BULDING 9 CLINICAL AFFAIRS
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1736
Mailing Address - Country:US
Mailing Address - Phone:404-504-5628
Mailing Address - Fax:404-364-4798
Practice Address - Street 1:3495 PIEDMONT RD. NE
Practice Address - Street 2:BULDING 9 CLINICAL AFFAIRS
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1736
Practice Address - Country:US
Practice Address - Phone:404-504-5628
Practice Address - Fax:404-364-4798
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist