Provider Demographics
NPI:1396013504
Name:TSAI, SUSAN SUE-SEN (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:SUE-SEN
Last Name:TSAI
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 1:2312 WOOD CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1937
Mailing Address - Country:US
Mailing Address - Phone:909-626-9549
Mailing Address - Fax:
Practice Address - Street 1:2312 WOOD CT
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1937
Practice Address - Country:US
Practice Address - Phone:909-626-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44454183500000X
TX32223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist