Provider Demographics
NPI:1760596019
Name:FILLMORE, SUSAN ELISABETH (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELISABETH
Last Name:FILLMORE
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 1:1034 LAMBETH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-5075
Mailing Address - Country:US
Mailing Address - Phone:614-370-6902
Mailing Address - Fax:740-869-3840
Practice Address - Street 1:283 YANKEETOWN ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:OH
Practice Address - Zip Code:43143-9410
Practice Address - Country:US
Practice Address - Phone:740-869-3784
Practice Address - Fax:740-869-3840
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03311834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist