Provider Demographics
NPI:1740490010
Name:LORENZETTI, SUSAN M (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LORENZETTI
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:RR 2 BOX 188A
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-9628
Mailing Address - Country:US
Mailing Address - Phone:570-254-9935
Mailing Address - Fax:
Practice Address - Street 1:125 SCRANTON POCONO HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2274
Practice Address - Country:US
Practice Address - Phone:570-963-2305
Practice Address - Fax:570-963-2306
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040214L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist