Provider Demographics
NPI:1588269500
Name:BARNES, SUZANNE KATHLEEN
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KATHLEEN
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:KATHLEEN
Other - Last Name:FIRESTINE-BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:197 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1311
Mailing Address - Country:US
Mailing Address - Phone:570-662-2615
Mailing Address - Fax:570-662-7434
Practice Address - Street 1:197 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1311
Practice Address - Country:US
Practice Address - Phone:570-662-2615
Practice Address - Fax:570-662-7434
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034457L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist