Provider Demographics
NPI:1316951841
Name:OLIN, SUZANNE ELIZABETH PENCE (PHARMD, RPH)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELIZABETH PENCE
Last Name:OLIN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:MS
Other - First Name:SUZSNNR
Other - Middle Name:ELIAZBETH
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 N ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2228
Mailing Address - Country:US
Mailing Address - Phone:541-231-3773
Mailing Address - Fax:
Practice Address - Street 1:2865 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1106
Practice Address - Country:US
Practice Address - Phone:541-883-6263
Practice Address - Fax:541-883-6216
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist