Provider Demographics
NPI:1285529230
Name:MPACKO, SUZANNE ANNIE SANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:SUZANNE ANNIE
Middle Name:SANDRA
Last Name:MPACKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 THAYER AVE APT 632
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4589
Mailing Address - Country:US
Mailing Address - Phone:240-381-0589
Mailing Address - Fax:
Practice Address - Street 1:10125 WARD RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2717
Practice Address - Country:US
Practice Address - Phone:443-550-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist