Provider Demographics
NPI:1396838124
Name:ALLEN, SUSAN LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LEE
Other - Last Name:LINDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10004 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-3930
Mailing Address - Country:US
Mailing Address - Phone:402-896-7952
Mailing Address - Fax:402-896-3774
Practice Address - Street 1:10004 S 152ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3930
Practice Address - Country:US
Practice Address - Phone:402-896-7952
Practice Address - Fax:402-896-3774
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10367183500000X
NV16455183500000X
AZS016566183500000X
LAPST.018511183500000X
KY13985183500000X
TN32994183500000X
VA0202212862183500000X
KS1-16343183500000X
ORRPH-00139811835P0018X
ARPD13077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist