Susan Burgess
Individual provider Active NPI Pharmacist · Fortuna, CA
NPI 1003406166 · NPPES record last updated Jan 22, 2021
Key facts
- NPI
- 1003406166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 58285 (CA)
- Practice address
- 1058 Main St
Fortuna, CA 95540-2009 - Phone
- (707) 725-3040
- Fax
- (707) 726-2671
- NPI assigned
- Jan 22, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 58285 | CA | Yes |
Addresses
Primary practice location
1058 Main St
Fortuna, CA 95540-2009
Mailing address
1058 Main St
Fortuna, CA 95540-2009
Phone (707) 725-3040
Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.