Provider Demographics
NPI:1205141942
Name:PRESLEY, SUSAN DIANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANE
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:PRESLEY-JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:641 E HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7055
Mailing Address - Country:US
Mailing Address - Phone:512-396-2892
Mailing Address - Fax:512-392-7896
Practice Address - Street 1:641 E HOPKINS ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7055
Practice Address - Country:US
Practice Address - Phone:512-396-2892
Practice Address - Fax:512-392-7896
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist