Provider Demographics
NPI:1023624749
Name:DUN, MARIA SUSAN
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SUSAN
Last Name:DUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5111
Mailing Address - Country:US
Mailing Address - Phone:718-356-1789
Mailing Address - Fax:718-356-1777
Practice Address - Street 1:3948 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5111
Practice Address - Country:US
Practice Address - Phone:718-356-1789
Practice Address - Fax:718-356-1777
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist