Provider Demographics
NPI:1386910446
Name:SUITOR, MARK R (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:SUITOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 LAKE LEELANAU DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7776
Mailing Address - Country:US
Mailing Address - Phone:231-463-6671
Mailing Address - Fax:
Practice Address - Street 1:4144 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9228
Practice Address - Country:US
Practice Address - Phone:231-943-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist