Provider Demographics
NPI:1396177259
Name:MAHONEY-WEBER, SUSAN M (PHARMD RPH)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:MAHONEY-WEBER
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 38TH ST NW STE DEF
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2953
Mailing Address - Country:US
Mailing Address - Phone:701-492-9196
Mailing Address - Fax:
Practice Address - Street 1:706 38TH ST NW STE DEF
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2953
Practice Address - Country:US
Practice Address - Phone:701-893-9050
Practice Address - Fax:800-340-2621
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND 47531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist