Provider Demographics
NPI:1124341128
Name:BANCROFT, SUSAN K (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:BANCROFT
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 1:3616 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6302
Mailing Address - Country:US
Mailing Address - Phone:716-648-7860
Mailing Address - Fax:
Practice Address - Street 1:316 S.CASCADE DR.
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141
Practice Address - Country:US
Practice Address - Phone:716-592-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist