Provider Demographics
NPI:1235726852
Name:MCNUTT, SUSAN (PD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 OLD ARKANA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-7471
Mailing Address - Country:US
Mailing Address - Phone:870-404-8848
Mailing Address - Fax:
Practice Address - Street 1:1577 OLD ARKANA RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-7471
Practice Address - Country:US
Practice Address - Phone:870-404-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist