Provider Demographics
NPI:1750604187
Name:DUTTON, SUSANNAH JO (PHARMD)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:JO
Last Name:DUTTON
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 1:11601 APRILBUD DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-8709
Mailing Address - Country:US
Mailing Address - Phone:804-317-1578
Mailing Address - Fax:
Practice Address - Street 1:6851 TEMIE LEE PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2087
Practice Address - Country:US
Practice Address - Phone:804-639-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-13
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206509183500000X
IL051289579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist