Provider Demographics
NPI:1811085913
Name:TOWN RICHARDS, SUSAN JEAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:TOWN RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 CROUCH
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-768-1021
Mailing Address - Fax:
Practice Address - Street 1:300 W WASHINGTON
Practice Address - Street 2:STE 110
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-784-3430
Practice Address - Fax:517-784-5822
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician