Provider Demographics
NPI:1154535151
Name:HALLEN, SUSAN K
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:HALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:HALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:603 N 4TH ST
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-0808
Mailing Address - Country:US
Mailing Address - Phone:701-567-2292
Mailing Address - Fax:
Practice Address - Street 1:603 N 4TH ST
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-0808
Practice Address - Country:US
Practice Address - Phone:701-567-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist