Provider Demographics
NPI:1891772364
Name:BALKARAN, SUSAN (BS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BALKARAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TECHNOLOGY PARK STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6298
Mailing Address - Country:US
Mailing Address - Phone:877-453-4566
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY PARK STE 100
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6298
Practice Address - Country:US
Practice Address - Phone:877-453-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist