Provider Demographics
NPI:1336414903
Name:GERMAN, SUSAN J (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:GERMAN
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 1:10 GARET PL
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5421
Mailing Address - Country:US
Mailing Address - Phone:631-462-5098
Mailing Address - Fax:631-462-5283
Practice Address - Street 1:10 GARET PL
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5421
Practice Address - Country:US
Practice Address - Phone:631-462-5098
Practice Address - Fax:631-462-5283
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist