Provider Demographics
NPI:1194062224
Name:PICKETT, SUSAN PORTUGUES (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PORTUGUES
Last Name:PICKETT
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 1:322 COX CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1540
Mailing Address - Country:US
Mailing Address - Phone:256-718-1795
Mailing Address - Fax:256-513-6291
Practice Address - Street 1:322 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1540
Practice Address - Country:US
Practice Address - Phone:256-718-1795
Practice Address - Fax:256-513-6291
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist