MEDICARE: SUSAN HOMAN

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	03-3-18375	OH

General Provider Information

NPI Number	:	1629132105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HOMAN

Provider Business Mailing Address
First Line	:	746 WATKINS RD
Second Line	:
City	:	FORT RECOVERY
State	:	OH
Zip	:	45846-9124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 EAST BUTLER STREET
Second Line	:
City	:	FORT RECOVERY
State	:	OH
Zip	:	45846
Country	:	US
Telephone Number	:	419-375-2323
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN HOMAN ” Practice Location

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