Provider Demographics
NPI:1407863087
Name:HOHENSTEIN, SUSAN ELLEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELLEN
Last Name:HOHENSTEIN
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 1:265 N WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1411
Mailing Address - Country:US
Mailing Address - Phone:419-908-1563
Mailing Address - Fax:
Practice Address - Street 1:306 W WATER ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1336
Practice Address - Country:US
Practice Address - Phone:419-898-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020676450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849130Medicaid
0532140001Medicare ID - Type Unspecified