Provider Demographics
NPI:1770821274
Name:OSTHOFF, SUZANNE MCMAHON
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MCMAHON
Last Name:OSTHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E VAN FLEET DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3831
Mailing Address - Country:US
Mailing Address - Phone:863-534-1824
Mailing Address - Fax:
Practice Address - Street 1:255 E VAN FLEET DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3831
Practice Address - Country:US
Practice Address - Phone:863-534-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist