Provider Demographics
NPI:1730110511
Name:BARTTELBORT, SUSAN ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:BARTTELBORT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:GONYOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5766 SNOWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7904
Mailing Address - Country:US
Mailing Address - Phone:307-635-6610
Mailing Address - Fax:
Practice Address - Street 1:6101 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3445
Practice Address - Country:US
Practice Address - Phone:307-432-4461
Practice Address - Fax:307-432-4402
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11484183500000X
WY2396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist