Provider Demographics
NPI:1184212847
Name:PIEPER, SUSAN SMITH (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SMITH
Last Name:PIEPER
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 1:205 SOUTH RUSTON
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-459-3809
Mailing Address - Fax:
Practice Address - Street 1:3900 OAK HILL
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711
Practice Address - Country:US
Practice Address - Phone:812-459-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2601136A1835P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0200XPharmacy Service ProvidersPharmacistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26013386AOther26013386A
00000OtherVACCINATIONS
IN1000000000OtherVACCINATIONS