Provider Demographics
NPI:1629391099
Name:FUJITA, SUZANNE (RPH)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:FUJITA
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:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:SHELTER ISLAND HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11965-1163
Mailing Address - Country:US
Mailing Address - Phone:631-749-0445
Mailing Address - Fax:
Practice Address - Street 1:19 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11965
Practice Address - Country:US
Practice Address - Phone:631-749-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1871508499Medicaid