Provider Demographics
NPI:1033556816
Name:PRESTON, SUSAN C (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:PRESTON
Suffix:
Gender:F
Credentials: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 2557
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2557
Mailing Address - Country:US
Mailing Address - Phone:912-384-1898
Mailing Address - Fax:912-383-7109
Practice Address - Street 1:250 PETERSON AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5237
Practice Address - Country:US
Practice Address - Phone:912-384-1898
Practice Address - Fax:912-383-7109
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist