Provider Demographics
NPI:1295020733
Name:GREER, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 W FLORISSANT AVE
Mailing Address - Street 2:T-2050
Mailing Address - City:JENNINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1400
Mailing Address - Country:US
Mailing Address - Phone:314-513-0195
Mailing Address - Fax:
Practice Address - Street 1:8007 W FLORISSANT AVE
Practice Address - Street 2:T-2050
Practice Address - City:JENNINGS
Practice Address - State:MO
Practice Address - Zip Code:63136-1400
Practice Address - Country:US
Practice Address - Phone:314-513-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005006956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist