Provider Demographics
NPI:1891713426
Name:SHIELDS, SUSAN MARGARET (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARGARET
Last Name:SHIELDS
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 1:732 18TH ST APT 401
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1027
Mailing Address - Country:US
Mailing Address - Phone:515-571-5957
Mailing Address - Fax:
Practice Address - Street 1:250 ELM AVENUE SW
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:IA
Practice Address - Zip Code:50169
Practice Address - Country:US
Practice Address - Phone:515-725-5065
Practice Address - Fax:515-725-5070
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891713426OtherNPI