Provider Demographics
NPI:1881042133
Name:SMITH, SUSAN ODNEAL (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ODNEAL
Last Name:SMITH
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 1:11100 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1205
Mailing Address - Country:US
Mailing Address - Phone:913-777-3904
Mailing Address - Fax:866-930-4147
Practice Address - Street 1:11100 NALL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1205
Practice Address - Country:US
Practice Address - Phone:913-777-3904
Practice Address - Fax:866-930-4147
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-10873183500000X
MD21051183500000X
WVRP0008549183500000X
MI302044292183500000X
OK16775183500000X
AZS017684183500000X
MO41807183500000X
VA202209011183500000X
NY061582-1183500000X
MST-12126183500000X
LA17652183500000X
AL18232183500000X
MAPH236530183500000X
KY013095183500000X
ORRPH-0011616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist