Provider Demographics
NPI:1548360183
Name:LIGHT, SUZANNE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:LIGHT
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 1:3233 CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-8159
Mailing Address - Country:US
Mailing Address - Phone:406-265-2888
Mailing Address - Fax:
Practice Address - Street 1:20 13TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5222
Practice Address - Country:US
Practice Address - Phone:406-262-1756
Practice Address - Fax:406-262-1628
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5204183500000X
AZ10929183500000X
CARPH 48224183500000X
VT033-0003635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 48224OtherCALIFORNIA STATE LICENSE
VT033-0003635OtherVERMONT STATE LICENSE
MT5204OtherMONTANA STATE LICENSE
AZ10929OtherARIZONA STATE LICENSE