Provider Demographics
NPI:1356680110
Name:RASBACH, SUSAN SHUTT (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHUTT
Last Name:RASBACH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WHITEHALL CT
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3301
Mailing Address - Country:US
Mailing Address - Phone:731-607-4634
Mailing Address - Fax:901-290-9271
Practice Address - Street 1:11635 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9778
Practice Address - Country:US
Practice Address - Phone:901-290-9270
Practice Address - Fax:901-290-9271
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist