Provider Demographics
NPI:1902128689
Name:HARRISON, SUSAN MARLENE (BS PHARMACY)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARLENE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MELANIE WAY
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4649
Mailing Address - Country:US
Mailing Address - Phone:631-864-5571
Mailing Address - Fax:
Practice Address - Street 1:820 FORT SALONGA RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3151
Practice Address - Country:US
Practice Address - Phone:631-261-1057
Practice Address - Fax:631-754-0285
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist