Provider Demographics
NPI:1720332950
Name:KOESY, SUZANNE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:KOESY
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 1:4 BANGOR CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4900
Mailing Address - Country:US
Mailing Address - Phone:501-765-3662
Mailing Address - Fax:
Practice Address - Street 1:9200 N RODNEY PARHAM RD
Practice Address - Street 2:WALGREENS PHARMACIST
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-6202
Practice Address - Country:US
Practice Address - Phone:501-223-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist