Provider Demographics
NPI:1841572708
Name:DELEO, SUSAN A
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:DELEO
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 1:15 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6042
Mailing Address - Country:US
Mailing Address - Phone:603-472-2346
Mailing Address - Fax:603-471-9356
Practice Address - Street 1:15 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6042
Practice Address - Country:US
Practice Address - Phone:603-472-2346
Practice Address - Fax:603-471-9356
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2278183500000X
MA21625183500000X
VT033-0003874183500000X
IL051.288217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist