Provider Demographics
NPI:1356640445
Name:BRICKER, SUE ELLEN DAVIS
Entity Type:Individual
Prefix:MRS
First Name:SUE ELLEN
Middle Name:DAVIS
Last Name:BRICKER
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 1:219 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3104
Mailing Address - Country:US
Mailing Address - Phone:318-473-2895
Mailing Address - Fax:318-473-2895
Practice Address - Street 1:219 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3104
Practice Address - Country:US
Practice Address - Phone:318-473-2895
Practice Address - Fax:318-473-2895
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist