Provider Demographics
NPI:1932545852
Name:LUNIAK, SUZANNE MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARY
Last Name:LUNIAK
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 1:2101 E EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9001
Mailing Address - Country:US
Mailing Address - Phone:920-733-2305
Mailing Address - Fax:
Practice Address - Street 1:2101 E EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9001
Practice Address - Country:US
Practice Address - Phone:920-733-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10069-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10069-40OtherWISCONSIN PHARMACY LISCENSE