Provider Demographics
NPI:1063518728
Name:DUFFETT, SUSAN ELIZABETH (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:DUFFETT
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 1:508 JOHNNY WALKER LN STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-1804
Mailing Address - Country:US
Mailing Address - Phone:816-776-6926
Mailing Address - Fax:816-776-3144
Practice Address - Street 1:508 JOHNNY WALKER LN STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1804
Practice Address - Country:US
Practice Address - Phone:816-776-6926
Practice Address - Fax:816-776-3144
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist