MEDICARE: SUSAN HORVATH

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	0202007794	VA

General Provider Information

NPI Number	:	1790816684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HORVATH

Provider Business Mailing Address
First Line	:	4608 DELCO RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-2842
Country	:	US
Telephone Number	:	757-363-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 WILL O WISP DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3102
Country	:	US
Telephone Number	:	757-362-9430
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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