Provider Demographics
NPI:1922579465
Name:CRUICKSHANK, SUSAN CANDACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CANDACE
Last Name:CRUICKSHANK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:CRUICKSHANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6567 W 96TH DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5428
Mailing Address - Country:US
Mailing Address - Phone:720-989-5770
Mailing Address - Fax:
Practice Address - Street 1:1375 E SOUTH BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027
Practice Address - Country:US
Practice Address - Phone:303-673-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1871538892OtherSTORE NPI
CO1487680062OtherSTORE NPI
CO1730116260OtherSTORE NPI
CO1003843533OtherSTORE NPI
CO1205871977OtherSTORE NPI
CO1477589943OtherSTORE NPI
CO1962959569OtherSTORE NPI
CO1326083098OtherSTORE NPI
CO1437187523OtherSTORE NPI