Provider Demographics
NPI:1518627256
Name:KASPAROV, SUSAN Y (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:Y
Last Name:KASPAROV
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 BERGEN TPKE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2390
Practice Address - Country:US
Practice Address - Phone:886-773-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2025-03-16
Deactivation Date:2022-03-07
Deactivation Code:
Reactivation Date:2024-12-03
Provider Licenses
StateLicense IDTaxonomies
NYI071257-01183500000X
NJ28RI04219200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist