Provider Demographics
NPI:1205814324
Name:WRIGHT, SUSAN J (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:WRIGHT
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 1:1535 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3102
Mailing Address - Country:US
Mailing Address - Phone:231-759-1150
Mailing Address - Fax:
Practice Address - Street 1:17717 174TH ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456
Practice Address - Country:US
Practice Address - Phone:616-842-4706
Practice Address - Fax:616-842-4716
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist