Provider Demographics
NPI:1992073449
Name:WEILER, SUSAN GOSDIN (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GOSDIN
Last Name:WEILER
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 1:2784 CARL T JONES DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-4909
Mailing Address - Country:US
Mailing Address - Phone:256-882-2883
Mailing Address - Fax:256-882-2982
Practice Address - Street 1:2784 CARL T JONES DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-882-2883
Practice Address - Fax:256-882-2982
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist