Provider Demographics
NPI:1629351010
Name:HERMANN, SUSAN DEAN (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEAN
Last Name:HERMANN
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 1:5990 W BRYANTS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-9328
Mailing Address - Country:US
Mailing Address - Phone:765-349-6198
Mailing Address - Fax:
Practice Address - Street 1:455 E EPLER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1902
Practice Address - Country:US
Practice Address - Phone:317-788-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014933A183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy