Provider Demographics
NPI:1336140532
Name:WEST, SUSAN DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:WEST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SPORTSMAN CLUB LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9256
Mailing Address - Country:US
Mailing Address - Phone:270-726-9010
Mailing Address - Fax:
Practice Address - Street 1:990 SPORTSMAN CLUB LN
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9256
Practice Address - Country:US
Practice Address - Phone:270-726-9010
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71041835P1200X
IN26091584A1835P1200X
TN92151835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy