Provider Demographics
NPI:1376415984
Name:HARUTYUNYAN, SUSANNA (RPH)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:HARUTYUNYAN
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 1:239 SILVER LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3337
Mailing Address - Country:US
Mailing Address - Phone:929-355-8594
Mailing Address - Fax:
Practice Address - Street 1:239 SILVER LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3337
Practice Address - Country:US
Practice Address - Phone:929-355-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ16059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist