Provider Demographics
NPI:1275823833
Name:ROSSELIT, SUSANNE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:LYNN
Last Name:ROSSELIT
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 1:7890 WINDING WAY S
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9258
Mailing Address - Country:US
Mailing Address - Phone:937-864-1603
Mailing Address - Fax:937-864-2176
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1233
Practice Address - Country:US
Practice Address - Phone:937-864-1603
Practice Address - Fax:937-864-2176
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist