MEDICARE: VONNY SUZANTY

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	65027	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174995492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VONNY SUZANTY

Provider Business Mailing Address
First Line	:	2662 DEL MAR HEIGHTS RD
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3100
Country	:	US
Telephone Number	:	858-481-8601
Fax Number	:	858-259-9652

Provider Business Practice Location Address
First Line	:	2662 DEL MAR HEIGHTS RD
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-3100
Country	:	US
Telephone Number	:	858-481-8601
Fax Number	:	858-259-9652

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

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “ VONNY SUZANTY ” Practice Location

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