Most Relevant Information
Provider Data
| NPI Number: | 1003406166 |
| Provider Name: | SUSAN BURGESS |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 58285 |
Most Important Dates
| Enumeration Date: | 01/22/2021 |
| Last Updated: | 01/22/2021 |
Provider Practice Location
1058 MAIN ST
FORTUNA
CA
955402009
Practice Location Phone/Fax
| Phone: | 7077253040 |
| Fax: | 7077262671 |
Provider Mailing Location
1058 MAIN ST
FORTUNA
CA
955402009
Provider Mailing Phone/Fax
| Phone: | 7077253040 |
| Fax: |