Healthcare Provider Details

I. General information

NPI: 1407936677
Provider Name (Legal Business Name): SUSAN MILLIKEN HOLDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

15 JUNIPER RD
MEDWAY MA
02053-2439
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-5389
  • Fax:
Mailing address:
  • Phone: 617-383-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number9974
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number9974
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9974
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: