Provider Demographics
NPI:1306109046
Name:HUGHES, SUSAN A (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:HUGHES
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 1:7301 JAMAICA WAY
Mailing Address - Street 2:APT #3
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8900
Mailing Address - Country:US
Mailing Address - Phone:513-492-8023
Mailing Address - Fax:
Practice Address - Street 1:4341 FEEDWIRE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3970
Practice Address - Country:US
Practice Address - Phone:937-439-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-25501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSO16969OtherARIZONA STATE PHARMACY LICENSE
OH03-3-25501OtherOHIO STATE PHARMACY LICENSE