Provider Demographics
NPI:1013007574
Name:BENTOW, SUSAN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:BENTOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 DAPPLEGRAY RD
Mailing Address - Street 2:
Mailing Address - City:BELL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1011
Mailing Address - Country:US
Mailing Address - Phone:818-887-4398
Mailing Address - Fax:
Practice Address - Street 1:5353 BALBOA
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-788-2411
Practice Address - Fax:818-981-4947
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist