Provider Demographics
NPI:1790007029
Name:JOSHUA, SUSAN JOJI
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOJI
Last Name:JOSHUA
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 1:73 SWEETGUM LN
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3005
Mailing Address - Country:US
Mailing Address - Phone:631-320-7359
Mailing Address - Fax:
Practice Address - Street 1:10 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2615
Practice Address - Country:US
Practice Address - Phone:631-724-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051578-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist