Provider Demographics
NPI:1124244249
Name:REEVES, SUSAN GRACE (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:GRACE
Last Name:REEVES
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 1:16 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1221
Mailing Address - Country:US
Mailing Address - Phone:585-594-5929
Mailing Address - Fax:
Practice Address - Street 1:3660 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3026
Practice Address - Country:US
Practice Address - Phone:585-621-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist