Provider Demographics
NPI:1043297617
Name:DITTER, SUZANNE MARIE (PHARM D)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:DITTER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 BLAISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5502
Mailing Address - Country:US
Mailing Address - Phone:612-719-7727
Mailing Address - Fax:
Practice Address - Street 1:15111 TWELVE OAKS CENTER DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5201
Practice Address - Country:US
Practice Address - Phone:952-993-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP52144183500000X
MN118775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist