Provider Demographics
NPI:1396019907
Name:SUROZENSKI, VIRGINIA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARIE
Last Name:SUROZENSKI
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 1:1525 CROWN LAND LN
Mailing Address - Street 2:PO BOX 92
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1254
Mailing Address - Country:US
Mailing Address - Phone:631-734-6711
Mailing Address - Fax:
Practice Address - Street 1:1525 CROWN LAND LN
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1254
Practice Address - Country:US
Practice Address - Phone:631-734-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist