Provider Demographics
NPI:1902469398
Name:HARR, SUSAN R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:HARR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:HADEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4625 S MASON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3740
Mailing Address - Country:US
Mailing Address - Phone:970-372-3481
Mailing Address - Fax:
Practice Address - Street 1:4625 S MASON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3740
Practice Address - Country:US
Practice Address - Phone:970-372-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist