1447536024 NPI number — MRS. SUZANNE EILEEN SLIKER RPH

Table of content: MRS. SUZANNE EILEEN SLIKER RPH (NPI 1447536024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447536024 NPI number — MRS. SUZANNE EILEEN SLIKER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLIKER
Provider First Name:
SUZANNE
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COPPOLA
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
EILEEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447536024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 SHWEKY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06489-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-621-2624
Provider Business Mailing Address Fax Number:
860-621-6408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 MAIN ST
Provider Second Line Business Practice Location Address:
WALGREENS #7641
Provider Business Practice Location Address City Name:
SOUTHINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06489-4538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-621-3729
Provider Business Practice Location Address Fax Number:
860-621-6408
Provider Enumeration Date:
10/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  7627 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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