Provider Demographics
NPI:1144812157
Name:PATOTA, SUSAN CHERYL (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHERYL
Last Name:PATOTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1349
Mailing Address - Country:US
Mailing Address - Phone:401-624-8421
Mailing Address - Fax:401-624-1298
Practice Address - Street 1:500 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1349
Practice Address - Country:US
Practice Address - Phone:401-624-8421
Practice Address - Fax:401-624-1298
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist