Provider Demographics
NPI:1265032965
Name:BARTON, SUSAN RAYLETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RAYLETTE
Last Name:BARTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:RAYLETTE
Other - Middle Name:
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1307 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5978
Mailing Address - Country:US
Mailing Address - Phone:636-980-9300
Mailing Address - Fax:636-978-8447
Practice Address - Street 1:1307 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5978
Practice Address - Country:US
Practice Address - Phone:636-980-9300
Practice Address - Fax:636-978-8447
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist