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General NPI Number Information
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NPI Number | 1356331706
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Entity Type | Individual
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Provider Name | GREGORY JOHN SUSKO R.PH.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 4332 CLEVELAND AVE NW
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City | CANTON
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State | OH
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Zip | 44709-2352
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Country | US
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Telephone | 330-649-9709
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Fax |
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Provider Business Mailing Address
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Address Line | 6437 MEADOWSWEET AVE NW
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City | CANTON
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State | OH
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Zip | 44718-3937
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Country | US
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Telephone | 330-966-1370
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-2-16764
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License Number State | OH
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