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General NPI Number Information
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NPI Number | 1396157897
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Entity Type | Organization
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Legal Business Name | SUSY'S PHARMACY, INC.
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 12887 SW 42 ST
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City | MIAMI
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State | FL
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Zip | 33175
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Country | US
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Telephone | 786-616-8668
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Fax | 786-616-8683
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Provider Business Mailing Address
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Address Line | 12887 SW 42 ST
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City | MIAMI
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State | FL
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Zip | 33175
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Country | US
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Telephone | 786-616-8668
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Fax | 786-616-8683
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARCIA GONGORA
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Credential | RPT55235
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Telephone | 786-797-4943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28182
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License Number State | FL
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