Provider Demographics
NPI:1194058032
Name:DEMONT, SUSAN L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:DEMONT
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 1:7850 ENCHANTED HILLS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-8623
Mailing Address - Country:US
Mailing Address - Phone:505-771-2777
Mailing Address - Fax:505-771-2772
Practice Address - Street 1:7850 ENCHANTED HILLS BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8623
Practice Address - Country:US
Practice Address - Phone:505-771-2777
Practice Address - Fax:505-771-2772
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist