Provider Demographics
NPI:1548537947
Name:CANNIFF, SUSAN JANE (RPH)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANE
Last Name:CANNIFF
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 1:2099 FORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1814
Mailing Address - Country:US
Mailing Address - Phone:651-414-3882
Mailing Address - Fax:651-414-3888
Practice Address - Street 1:2099 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1814
Practice Address - Country:US
Practice Address - Phone:651-414-3882
Practice Address - Fax:651-414-3888
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119903183500000X
CO12485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12485OtherPHARMACIST LICENSE
MN119903OtherMINNESOTA PHARMACY LICENSE NUMBER