Provider Demographics
NPI:1932796778
Name:CHEVARIE, SUSAN ELAINE
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELAINE
Last Name:CHEVARIE
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 1:90 HILL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-6202
Mailing Address - Country:US
Mailing Address - Phone:978-660-5309
Mailing Address - Fax:
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2902
Practice Address - Country:US
Practice Address - Phone:978-632-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist