Healthcare Provider Details

I. General information

NPI: 1215233994
Provider Name (Legal Business Name): SUSAN C MITRI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 N ABBY ST
FRESNO CA
93720-2920
US

IV. Provider business mailing address

7100 N ABBY ST
FRESNO CA
93720-2920
US

V. Phone/Fax

Practice location:
  • Phone: 559-437-3642
  • Fax: 559-437-3663
Mailing address:
  • Phone: 559-437-3642
  • Fax: 559-437-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 49526
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number49526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: