Provider Demographics
NPI:1811201155
Name:NUSE, JANET W (RPH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:W
Last Name:NUSE
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 1:950 COUNTY ROAD 105
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-8723
Mailing Address - Country:US
Mailing Address - Phone:660-248-5117
Mailing Address - Fax:
Practice Address - Street 1:950 COUNTY ROAD 105
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-8723
Practice Address - Country:US
Practice Address - Phone:660-248-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist