Provider Demographics
NPI:1740563683
Name:HART, SUZAN ASHLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:ASHLEY
Last Name:HART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SPRING TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6488
Mailing Address - Country:US
Mailing Address - Phone:636-922-5474
Mailing Address - Fax:
Practice Address - Street 1:1301 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2457
Practice Address - Country:US
Practice Address - Phone:636-946-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006021582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist