Provider Demographics
NPI:1750435822
Name:SUFFERN, LUCILLE MARY (BS, CPHT, CPT1)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARY
Last Name:SUFFERN
Suffix:
Gender:F
Credentials:BS, CPHT, CPT1
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38256 MEMBERS CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5859
Mailing Address - Country:US
Mailing Address - Phone:714-420-4326
Mailing Address - Fax:
Practice Address - Street 1:38256 MEMBERS CLUB DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5859
Practice Address - Country:US
Practice Address - Phone:714-420-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH16544183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA636053OtherNATIONAL CENTER FOR COMPETENCY TESTING
CATCH16544OtherPHARMACY TECH LICENSE
CACPT33756OtherCERTIFIED PHLEBOTOMIST DEPARTMENT OF PUBLIC HEALTH