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NPI Code Detail

MEDICARE: GREGORY JOHN SUSKO R.PH.

MEDICARE: GREGORY JOHN SUSKO R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03-2-16764OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13673919OTHEROHNCPDP

General Provider Information

NPI Number : 1356331706
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY JOHN SUSKO R.PH.
Provider Business Mailing Address
First Line : 6437 MEADOWSWEET AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44718-3937
Country : US
Telephone Number : 330-966-1370
Fax Number :
Provider Business Practice Location Address
First Line : 4332 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44709-2352
Country : US
Telephone Number : 330-649-9709
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 11/05/2007

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