Healthcare Provider Details

I. General information

NPI: 1972566420
Provider Name (Legal Business Name): SUSAN ALICE BULLARD PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST PHARMACY SERVICE (119)
DURHAM NC
27705-3875
US

IV. Provider business mailing address

508 FULTON ST
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-286-6987
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12406
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS27871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: