Provider Demographics
NPI:1982209391
Name:NUSSEIBEH, SUZAN (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:
Last Name:NUSSEIBEH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 CREEKWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-1650
Mailing Address - Country:US
Mailing Address - Phone:763-291-8090
Mailing Address - Fax:
Practice Address - Street 1:3470 RIVER RAPIDS DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-4101
Practice Address - Country:US
Practice Address - Phone:763-427-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist