Provider Demographics
NPI:1760134894
Name:TO, SUSAN VAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VAN
Last Name:TO
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 1:2535 BRONXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4203
Mailing Address - Country:US
Mailing Address - Phone:646-899-7685
Mailing Address - Fax:
Practice Address - Street 1:32 E 170TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7013
Practice Address - Country:US
Practice Address - Phone:718-588-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist