Provider Demographics
NPI:1881850725
Name:BICKMORE, SUSAN L (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BICKMORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1315
Mailing Address - Country:US
Mailing Address - Phone:651-636-1714
Mailing Address - Fax:651-636-3342
Practice Address - Street 1:1752 TERRACE DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1315
Practice Address - Country:US
Practice Address - Phone:651-636-1714
Practice Address - Fax:651-636-3342
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist