MEDICARE: SUSAN A HUGHES RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-3-25501	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SO16969	OTHER	AZ	ARIZONA STATE PHARMACY LICENSE
2	03-3-25501	OTHER	OH	OHIO STATE PHARMACY LICENSE

General Provider Information

NPI Number	:	1306109046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A HUGHES RPH

Provider Business Mailing Address
First Line	:	7301 JAMAICA WAY
Second Line	:	APT #3
City	:	MAINEVILLE
State	:	OH
Zip	:	45039-8900
Country	:	US
Telephone Number	:	513-492-8023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4341 FEEDWIRE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3970
Country	:	US
Telephone Number	:	937-439-9357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	06/18/2012

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