Provider Demographics
NPI:1598080418
Name:REDMON, SUZANNE LOUISE (RPH)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:LOUISE
Last Name:REDMON
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 1:1005 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-7201
Mailing Address - Country:US
Mailing Address - Phone:706-278-1485
Mailing Address - Fax:706-278-3963
Practice Address - Street 1:1203 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8674
Practice Address - Country:US
Practice Address - Phone:706-226-6304
Practice Address - Fax:706-278-3963
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist