Provider Demographics
NPI:1245371277
Name:BROWN, SUSAN ELAINE (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:BROWN
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 1:2630 COUNTY HIGHWAY 74
Mailing Address - Street 2:
Mailing Address - City:MORRAL
Mailing Address - State:OH
Mailing Address - Zip Code:43337-9206
Mailing Address - Country:US
Mailing Address - Phone:740-465-3841
Mailing Address - Fax:740-465-3841
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6416
Practice Address - Country:US
Practice Address - Phone:740-383-7979
Practice Address - Fax:740-383-7019
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033117001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy