Provider Demographics
NPI:1568452118
Name:DAVIS, SUSANNE T (RPH)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:T
Last Name:DAVIS
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 1:404 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-7766
Mailing Address - Country:US
Mailing Address - Phone:318-418-0769
Mailing Address - Fax:
Practice Address - Street 1:213 DEPOT ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2819
Practice Address - Country:US
Practice Address - Phone:318-878-2261
Practice Address - Fax:318-878-9870
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1275271Medicaid
1911090OtherNABP