Healthcare Provider Details

I. General information

NPI: 1972589018
Provider Name (Legal Business Name): SUSAN ANN WALL PHARM. D., RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH OKINAWA, PSC 482
FPO AP
96362
US

IV. Provider business mailing address

PSC 482 BOX 2563
FPO AP
96362
US

V. Phone/Fax

Practice location:
  • Phone: 011816117467954
  • Fax:
Mailing address:
  • Phone: 01181989264551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006680
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: