Provider Demographics
NPI:1790905271
Name:BRISTOW-MARCALUS, SUZANNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:BRISTOW-MARCALUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12312 SAVANNA CT
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21813-1686
Mailing Address - Country:US
Mailing Address - Phone:410-352-3664
Mailing Address - Fax:410-352-5654
Practice Address - Street 1:10231 OLD OCEAN CITY BLVD
Practice Address - Street 2:STE 103, JAMES G. BARRETT MEDICAL BLDG
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-0071
Practice Address - Fax:410-629-0081
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist