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NPI Code Detail

MEDICARE: DR. RONALD SUSA PHARMD

MEDICARE: DR. RONALD SUSA PHARMD
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
1183500000XPharmacist79862CA

General Provider Information

NPI Number : 1437616661
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD SUSA PHARMD
Provider Business Mailing Address
First Line : 300 TRAVIS BLVD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-3804
Country : US
Telephone Number : 707-422-3460
Fax Number :
Provider Business Practice Location Address
First Line : 300 TRAVIS BLVD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-3804
Country : US
Telephone Number : 707-422-3460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2019
Last Update Date : 02/24/2019

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Directions to “ DR. RONALD SUSA PHARMD” Practice Location

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