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General NPI Number Information
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NPI Number | 1356699078
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Entity Type | Individual
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Provider Name | SUZANNE H FOMICH RPH
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Gender | Female
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 26611 DIXIE HWY STE 119
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City | PERRYSBURG
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State | OH
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Zip | 43551-1749
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Country | US
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Telephone | 419-873-2800
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Fax | 419-873-0494
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Provider Business Mailing Address
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Address Line | 26611 DIXIE HWY STE 119
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City | PERRYSBURG
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State | OH
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Zip | 43551-1749
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Country | US
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Telephone | 419-873-2800
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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 | 03132126-1
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302041370
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License Number State | MI
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