Provider Demographics
NPI:1649588328
Name:TAAFFE, SUSAN BROWN (RPH)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BROWN
Last Name:TAAFFE
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 1:771 GOLDWATER CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3911
Mailing Address - Country:US
Mailing Address - Phone:407-644-3034
Mailing Address - Fax:
Practice Address - Street 1:1260 PALM COAST PKWY SW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4700
Practice Address - Country:US
Practice Address - Phone:386-446-4699
Practice Address - Fax:386-446-4504
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0020211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist