Provider Demographics
NPI:1588090724
Name:SHUGHRUE, MARY SUSAN GEGOREK (RPH, BCACP, CDE)
Entity type:Individual
Prefix:
First Name:MARY SUSAN
Middle Name:GEGOREK
Last Name:SHUGHRUE
Suffix:
Gender:F
Credentials:RPH, BCACP, CDE
Other - Prefix:
Other - First Name:MARY SUSAN
Other - Middle Name:GEGOREK
Other - Last Name:SHUGHRUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH, BCACP, CDE
Mailing Address - Street 1:743 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2738
Mailing Address - Country:US
Mailing Address - Phone:650-393-4844
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:M/C 5616
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672221183500000X
PARP041121R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist