Provider Demographics
NPI:1164708376
Name:HEWES, SUE RENEE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:RENEE
Last Name:HEWES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E HATCH RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-4814
Mailing Address - Country:US
Mailing Address - Phone:209-538-8268
Mailing Address - Fax:209-538-1462
Practice Address - Street 1:2101 E HATCH RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-4814
Practice Address - Country:US
Practice Address - Phone:209-538-8268
Practice Address - Fax:209-538-1462
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist