Provider Demographics
NPI:1467762252
Name:VICTOR, SUSAN LEABERRY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEABERRY
Last Name:VICTOR
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 1:222 MEDICAL CIR
Mailing Address - Street 2:PHARMACY
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1179
Mailing Address - Country:US
Mailing Address - Phone:606-784-3674
Mailing Address - Fax:606-783-6693
Practice Address - Street 1:222 MEDICAL CIR
Practice Address - Street 2:PHARMACY
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-784-3674
Practice Address - Fax:606-783-6693
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007307183500000X
WVRP0003060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist