Provider Demographics
NPI:1265910616
Name:HAENN, SUZANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HAENN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25458 N US HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:EVANT
Mailing Address - State:TX
Mailing Address - Zip Code:76525-2514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1004 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-1572
Practice Address - Country:US
Practice Address - Phone:254-386-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist