Provider Demographics
NPI:1942266903
Name:JOHNSON, SUSAN FAUVER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:FAUVER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:FAUVER
Other - Last Name:SEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3072 KENOSHA DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5586
Mailing Address - Country:US
Mailing Address - Phone:507-289-3843
Mailing Address - Fax:
Practice Address - Street 1:MAYO CLINIC PHARMACY
Practice Address - Street 2:200 FIRST STREET SW
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-0395
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist