Healthcare Provider Details

I. General information

NPI: 1467028563
Provider Name (Legal Business Name): SUZANNE MARIE FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 06/01/2021
Certification Date: 05/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 OLD YORK RD
NEW CUMBERLAND PA
17070-2485
US

IV. Provider business mailing address

4595 N PROGRESS AVE
HARRISBURG PA
17110-3932
US

V. Phone/Fax

Practice location:
  • Phone: 717-774-0261
  • Fax: 717-774-2810
Mailing address:
  • Phone: 717-856-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number240101021157671
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: