Provider Demographics
NPI:1629331483
Name:HALE, SUSAN LYNN
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:HALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COUNTY ROAD 581
Mailing Address - Street 2:TARGET PHARMACY # 1382
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9261
Mailing Address - Country:US
Mailing Address - Phone:813-907-6682
Mailing Address - Fax:
Practice Address - Street 1:1201 COUNTY ROAD 581
Practice Address - Street 2:TARGET PHARMACY # 1382
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9261
Practice Address - Country:US
Practice Address - Phone:813-907-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist