Provider Demographics
NPI:1871841742
Name:MARTINE, SUSAN REUSS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:REUSS
Last Name:MARTINE
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 1:2026 E LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-2961
Mailing Address - Country:US
Mailing Address - Phone:856-691-2287
Mailing Address - Fax:
Practice Address - Street 1:2026 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-2961
Practice Address - Country:US
Practice Address - Phone:856-691-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01884500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist