Provider Demographics
NPI:1992188791
Name:CHEN, SUSAN S (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:CHEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:SHU
Other - Middle Name:NING
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:220 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3186
Mailing Address - Country:US
Mailing Address - Phone:909-599-8874
Mailing Address - Fax:909-599-8843
Practice Address - Street 1:220 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3186
Practice Address - Country:US
Practice Address - Phone:909-599-8874
Practice Address - Fax:909-599-8843
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 44011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist