Provider Demographics
NPI:1326165861
Name:WHETSTINE, SUSAN MICHELE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MICHELE
Last Name:WHETSTINE
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 1:109 CANON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-4902
Mailing Address - Country:US
Mailing Address - Phone:563-506-2137
Mailing Address - Fax:
Practice Address - Street 1:2400 2ND AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5260
Practice Address - Country:US
Practice Address - Phone:563-264-5810
Practice Address - Fax:563-264-5811
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist