Provider Demographics
NPI:1306194683
Name:WEBER, SUSAN MARY (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:WEBER
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 1:7420 MORGANFORD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2168
Mailing Address - Country:US
Mailing Address - Phone:314-752-7553
Mailing Address - Fax:
Practice Address - Street 1:4221 BAYLESS AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7513
Practice Address - Country:US
Practice Address - Phone:314-638-1000
Practice Address - Fax:314-638-8430
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist