Individual provider Active NPI

Suzanne Bristow-Marcalus, RPH

  • Pharmacist
  • Berlin, MD
National Provider Identifier
1790905271
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
11206 Issued in MD
Practice address
10231 Old Ocean City Blvd
Ste 103, James G. Barrett Medical BLDG
Berlin, MD 21811
Phone
(410) 629-0071
Fax
(410) 629-0081
NPI assigned
Apr 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 11206 MD Primary

Addresses

Primary practice location

10231 Old Ocean City Blvd
Ste 103, James G. Barrett Medical BLDG
Berlin, MD 21811

Mailing address

12312 Savanna CT
Bishopville, MD 21813-1686
Phone (410) 352-3664

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

LicenseStateTypeSpecialty
11206MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Oc Pharma, Inc Pharmacist Past Accepting new patients
A V P Pharma Inc 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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790905271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12312 SAVANNA CT",
            "city": "BISHOPVILLE",
            "state": "MD",
            "postal_code": "218131686",
            "telephone_number": "410-352-3664",
            "fax_number": "410-352-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10231 OLD OCEAN CITY BLVD",
            "address_2": "STE 103, JAMES G. BARRETT MEDICAL BLDG",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-629-0071",
            "fax_number": "410-629-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOW-MARCALUS",
        "first_name": "SUZANNE",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "11206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.