Provider Demographics
NPI:1336278787
Name:MILLWARD, SUSAN LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:MILLWARD
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 1:6740 CROCKER RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9514
Mailing Address - Country:US
Mailing Address - Phone:330-483-3670
Mailing Address - Fax:
Practice Address - Street 1:19601 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1811
Practice Address - Country:US
Practice Address - Phone:440-331-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-13806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist