Provider Demographics
NPI:1770795189
Name:BRABEC, SUSAN SUTHERLAND (R PH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:SUTHERLAND
Last Name:BRABEC
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5851
Mailing Address - Country:US
Mailing Address - Phone:601-366-2735
Mailing Address - Fax:
Practice Address - Street 1:2151 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5851
Practice Address - Country:US
Practice Address - Phone:601-366-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-69121835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric