Provider Demographics
NPI:1477845154
Name:PENCE, SUSAN KIRBY (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KIRBY
Last Name:PENCE
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:PO BOX 1501
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23181-1501
Mailing Address - Country:US
Mailing Address - Phone:804-843-2880
Mailing Address - Fax:804-843-4004
Practice Address - Street 1:345 14TH ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181-1501
Practice Address - Country:US
Practice Address - Phone:804-843-2880
Practice Address - Fax:804-843-4004
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist