Provider Demographics
NPI:1821350596
Name:KING, SUSAN A (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:KING
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 1:46 HOAGLAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5501
Mailing Address - Country:US
Mailing Address - Phone:908-904-0925
Mailing Address - Fax:732-826-8516
Practice Address - Street 1:95 NEW BRUNSWICK AVE # 101
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2294
Practice Address - Country:US
Practice Address - Phone:732-826-0600
Practice Address - Fax:732-826-8516
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI018262001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01826200OtherNEW JERSEY LISCENCE