Provider Demographics
NPI:1174736177
Name:CRASE, SUZANNE MARIE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:CRASE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1621
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-2621
Mailing Address - Country:US
Mailing Address - Phone:520-432-3560
Mailing Address - Fax:
Practice Address - Street 1:90 FIFTH ST.
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607
Practice Address - Country:US
Practice Address - Phone:520-364-7568
Practice Address - Fax:520-364-9053
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist