Provider Demographics
NPI:1669710299
Name:ROSADO-SHAPOW, SUSANA (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:ROSADO-SHAPOW
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 1:2824 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5050
Mailing Address - Country:US
Mailing Address - Phone:863-386-0202
Mailing Address - Fax:863-386-0213
Practice Address - Street 1:2824 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5050
Practice Address - Country:US
Practice Address - Phone:863-386-0202
Practice Address - Fax:863-386-0213
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist