Active NPI
Brandon Susa, RPH
- Pharmacist
- Albuquerque, NM
National Provider Identifier
1356944250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00009394
- Practice address
- 5001 Montgomery Blvd NE
Albuquerque, NM 87109-1308 - Phone
- (505) 881-5210
- NPI assigned
- Nov 21, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP00009394 | NM | Primary |
Addresses
Primary practice location
5001 Montgomery Blvd NE
Albuquerque, NM 87109-1308
Mailing address
1922 Cleopatra CT NE
Albuquerque, NM 87112-3504
Phone (312) 998-6703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00009394 | NM | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605916800000",
"number": "1356944250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1922 CLEOPATRA CT NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871123504",
"telephone_number": "312-998-6703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5001 MONTGOMERY BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871091308",
"telephone_number": "505-881-5210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSA",
"first_name": "BRANDON",
"name_prefix": "Dr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-21",
"last_updated": "2020-11-21",
"certification_date": "2020-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00009394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.