Provider Demographics
NPI:1740672278
Name:SUSYS PHARMACY INC
Entity type:Organization
Organization Name:SUSYS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLURONKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUFIDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-431-5766
Mailing Address - Street 1:12887 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3435
Mailing Address - Country:US
Mailing Address - Phone:786-431-5766
Mailing Address - Fax:786-431-5751
Practice Address - Street 1:12887 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3435
Practice Address - Country:US
Practice Address - Phone:786-431-5766
Practice Address - Fax:786-431-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH281823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150360OtherPK