Provider Demographics
NPI:1457699845
Name:MINOR, SUSAN W (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:MINOR
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 1:2310 S HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4616
Mailing Address - Country:US
Mailing Address - Phone:850-271-6190
Mailing Address - Fax:850-271-6191
Practice Address - Street 1:2310 S HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4616
Practice Address - Country:US
Practice Address - Phone:850-271-6190
Practice Address - Fax:850-271-6191
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26542183500000X
AL10124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist