Provider Demographics
NPI:1366765208
Name:KILE, SUSAN MARY (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:KILE
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 1:4 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1778
Mailing Address - Country:US
Mailing Address - Phone:518-885-7330
Mailing Address - Fax:518-885-7460
Practice Address - Street 1:4 FRONT ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1778
Practice Address - Country:US
Practice Address - Phone:518-885-7330
Practice Address - Fax:518-885-7460
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36367183500000X
VT2333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist