Provider Demographics
NPI:1942592530
Name:MACIAG, SUSAN J (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:MACIAG
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 1:1459 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7706
Mailing Address - Country:US
Mailing Address - Phone:401-273-4470
Mailing Address - Fax:401-273-1820
Practice Address - Street 1:1459 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7706
Practice Address - Country:US
Practice Address - Phone:401-273-4470
Practice Address - Fax:401-273-1820
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist