Healthcare Provider Details

I. General information

NPI: 1528082211
Provider Name (Legal Business Name): SUSAN DONALDSON PELLERIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAGE ST
NEW BEDFORD MA
02740-3464
US

IV. Provider business mailing address

14 ARROWHEAD LN
S DARTMOUTH MA
02748-2002
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-1515
  • Fax:
Mailing address:
  • Phone: 508-992-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16241
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: