Healthcare Provider Details

I. General information

NPI: 1689008872
Provider Name (Legal Business Name): ANDREA L SUSI PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2013
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ALBANY ST
BOSTON MA
02118-2755
US

IV. Provider business mailing address

780 ALBANY ST
BOSTON MA
02118-2755
US

V. Phone/Fax

Practice location:
  • Phone: 857-654-1000
  • Fax: 857-654-1100
Mailing address:
  • Phone: 857-654-1000
  • Fax: 857-654-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH234801
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0012784
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: