Provider Demographics
NPI:1710396007
Name:DROLLETTE, SUSAN E
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DROLLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1771
Mailing Address - Country:US
Mailing Address - Phone:518-483-3990
Mailing Address - Fax:
Practice Address - Street 1:289 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1771
Practice Address - Country:US
Practice Address - Phone:518-483-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist