Provider Demographics
NPI:1548363831
Name:SMITH, SUSAN L (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:SMITH
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 1:2660 FILMORE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3604
Mailing Address - Country:US
Mailing Address - Phone:801-487-9115
Mailing Address - Fax:
Practice Address - Street 1:200 S CENTRAL CAMPUS DR
Practice Address - Street 2:RM 156
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9149
Practice Address - Country:US
Practice Address - Phone:801-587-3363
Practice Address - Fax:801-587-3375
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT151810-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist