Provider Demographics
NPI:1720295884
Name:SUROWICZ, MARY LOUISE (R PH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:SUROWICZ
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4125
Mailing Address - Country:US
Mailing Address - Phone:973-916-1823
Mailing Address - Fax:973-478-0603
Practice Address - Street 1:393 PIAGET AVE. (ROUTE 46)
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3094
Practice Address - Country:US
Practice Address - Phone:973-478-0600
Practice Address - Fax:973-478-0603
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01326500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist