Provider Demographics
NPI:1275125759
Name:BAER-LUNA, SUSAN MERLE (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MERLE
Last Name:BAER-LUNA
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 1:535 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2452
Mailing Address - Country:US
Mailing Address - Phone:765-418-3696
Mailing Address - Fax:
Practice Address - Street 1:535 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2452
Practice Address - Country:US
Practice Address - Phone:765-418-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021274A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26021274AOtherPHARRMACIST LICENSE