Provider Demographics
NPI:1215233994
Name:MITRI, SUSAN C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:MITRI
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 1:7100 N ABBY ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2920
Mailing Address - Country:US
Mailing Address - Phone:559-437-3642
Mailing Address - Fax:559-437-3663
Practice Address - Street 1:7100 N ABBY ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2920
Practice Address - Country:US
Practice Address - Phone:559-437-3642
Practice Address - Fax:559-437-3663
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 49526183500000X
CA495261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist