Provider Demographics
NPI:1245479377
Name:MEAD, SUSAN E (PHARMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MEAD
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:CAMPUS BOX 119 THE APOTHECARY
Mailing Address - Street 2:UNIVERSITY OF COLORADO
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309
Mailing Address - Country:US
Mailing Address - Phone:303-492-8553
Mailing Address - Fax:303-492-4874
Practice Address - Street 1:18TH AND WARDENBURG DRIVE
Practice Address - Street 2:UNIVERSITY OF COLORADO
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309
Practice Address - Country:US
Practice Address - Phone:303-492-8553
Practice Address - Fax:303-492-4874
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist