Provider Demographics
NPI:1124326244
Name:BALCH, SUSAN MITCHELL (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MITCHELL
Last Name:BALCH
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 1:217 BROOKS DR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-7259
Mailing Address - Country:US
Mailing Address - Phone:256-381-1374
Mailing Address - Fax:
Practice Address - Street 1:805 S MONTGOMERY AVE
Practice Address - Street 2:RITE-AID 07051
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-3813
Practice Address - Country:US
Practice Address - Phone:256-383-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist