Provider Demographics
NPI:1891012118
Name:BEWLEY, SUSAN D (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:BEWLEY
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 1:1434 WELLS BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3153
Mailing Address - Country:US
Mailing Address - Phone:512-251-5286
Mailing Address - Fax:
Practice Address - Street 1:1434 WELLS BRANCH PKWY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3153
Practice Address - Country:US
Practice Address - Phone:512-251-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist