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General NPI Number Information
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NPI Number | 1902128689
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Entity Type | Individual
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Provider Name | SUSAN MARLENE HARRISON BS PHARMACY
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Gender | Female
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 820 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3151
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Country | US
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Telephone | 631-261-1057
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Fax | 631-754-0285
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Provider Business Mailing Address
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Address Line | 174 MELANIE WAY
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City | COMMACK
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State | NY
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Zip | 11725-4649
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Country | US
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Telephone | 631-864-5571
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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 | 030826
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License Number State | NY
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