MEDICARE: LESLIE R SUSKO RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	12632	NC

General Provider Information

NPI Number	:	1134409360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE R SUSKO RPH

Provider Business Mailing Address
First Line	:	1150 REVOLUTION MILL DR STE 3
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5086
Country	:	US
Telephone Number	:	336-285-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 REVOLUTION MILL DR STE 3
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405
Country	:	US
Telephone Number	:	336-285-7985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	05/15/2019

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