Provider Demographics
NPI:1508136854
Name:EADES, SUSAN G (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:EADES
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 1:107 KIOWA LN
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6751
Mailing Address - Country:US
Mailing Address - Phone:864-272-2701
Mailing Address - Fax:888-448-1725
Practice Address - Street 1:107 KIOWA LN
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6751
Practice Address - Country:US
Practice Address - Phone:864-272-2701
Practice Address - Fax:888-448-1725
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6872183500000X
NC9682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist