Provider Demographics
NPI:1528671864
Name:WOMMACK, SUZANNE ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:WOMMACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 HIGHWAY 61 N
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2885
Mailing Address - Country:US
Mailing Address - Phone:573-221-6557
Mailing Address - Fax:
Practice Address - Street 1:2305 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-2559
Practice Address - Country:US
Practice Address - Phone:573-754-5531
Practice Address - Fax:573-754-4454
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013022804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist