Provider Demographics
NPI:1912156142
Name:MILITELLO, SUZANNE (RPH)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MILITELLO
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 1:2744 SW 14TH DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-6027
Mailing Address - Country:US
Mailing Address - Phone:954-426-3367
Mailing Address - Fax:
Practice Address - Street 1:150 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4128
Practice Address - Country:US
Practice Address - Phone:954-481-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22175183500000X
FLPU4025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist