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SUSAN BURGESS
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1003406166
Individual Registrant: SUSAN BURGESS
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
1058 MAIN ST FORTUNA, CA 95540-2009 US
Tel: 707-725-3040 Fax: 707-726-2671
Tel: 707-725-3040 Fax: 707-726-2671
Contact information for business:
1058 MAIN ST FORTUNA, CA 95540-2009 US
Tel: 707-725-3040 Fax: --
Tel: 707-725-3040 Fax: --
Registration Information:
NPI: 1003406166
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | CA | 58285 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
