Provider Demographics
NPI:1427696152
Name:ANDERSON, SUZANNE DEE (RPH)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DEE
Last Name:ANDERSON
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 1:15115 CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4462
Mailing Address - Country:US
Mailing Address - Phone:531-222-7693
Mailing Address - Fax:
Practice Address - Street 1:16101 EVANS ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6447
Practice Address - Country:US
Practice Address - Phone:402-717-9770
Practice Address - Fax:402-717-0197
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18300183500000X
NE10695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist