Provider Demographics
NPI:1871878454
Name:PUTNEY, SUZANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:PUTNEY
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 1:4738 W GANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3308
Mailing Address - Country:US
Mailing Address - Phone:813-837-1848
Mailing Address - Fax:813-837-1965
Practice Address - Street 1:4738 W GANDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3308
Practice Address - Country:US
Practice Address - Phone:813-837-1848
Practice Address - Fax:813-837-1965
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS20405OtherBACHELOR OF SCIENCE PHARMACY
FLPS20405OtherSTATE OF FLORIDA