Provider Demographics
NPI:1285931626
Name:WALSH, SUSAN ELIZABETH (PHARMD, RPH)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7902
Mailing Address - Country:US
Mailing Address - Phone:910-392-1180
Mailing Address - Fax:
Practice Address - Street 1:2302 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7902
Practice Address - Country:US
Practice Address - Phone:910-392-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist