Provider Demographics
NPI:1841838190
Name:REPINE, SUSAN (PHARMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:REPINE
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 1:1034 STATE ROAD 229
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-6808
Mailing Address - Country:US
Mailing Address - Phone:812-933-6220
Mailing Address - Fax:
Practice Address - Street 1:1034 STATE ROAD 229
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-6808
Practice Address - Country:US
Practice Address - Phone:812-933-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032298821835P0018X
IN26023294A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist