Provider Demographics
NPI:1619374113
Name:HAHN, SUSAN MIYOUNG (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MIYOUNG
Last Name:HAHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MIYOUNG
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4279 S 76TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2804
Mailing Address - Country:US
Mailing Address - Phone:414-541-3836
Mailing Address - Fax:414-541-3951
Practice Address - Street 1:4279 S 76TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-2804
Practice Address - Country:US
Practice Address - Phone:414-541-3836
Practice Address - Fax:414-541-3951
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16721-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist