Provider Demographics
NPI:1427657618
Name:HOGUE, SUSAN MIMM (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MIMM
Last Name:HOGUE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:SARAH
Other - Last Name:HELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7757 EADS AVE UNIT A5
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4332
Mailing Address - Country:US
Mailing Address - Phone:412-760-9469
Mailing Address - Fax:
Practice Address - Street 1:7757 EADS AVE UNIT A5
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4332
Practice Address - Country:US
Practice Address - Phone:412-760-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031273L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist