Provider Demographics
NPI:1063707677
Name:KALAEI, SUSAN N (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:N
Last Name:KALAEI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MACDONALD AVE
Mailing Address - Street 2:T1507
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2307
Mailing Address - Country:US
Mailing Address - Phone:510-253-1001
Mailing Address - Fax:510-253-1011
Practice Address - Street 1:4500 MACDONALD AVE
Practice Address - Street 2:T1507
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2307
Practice Address - Country:US
Practice Address - Phone:510-253-1001
Practice Address - Fax:510-253-1011
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA 43149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist