Healthcare Provider Details

I. General information

NPI: 1841838190
Provider Name (Legal Business Name): SUSAN REPINE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 STATE ROAD 229
BATESVILLE IN
47006-6808
US

IV. Provider business mailing address

1034 STATE ROAD 229
BATESVILLE IN
47006-6808
US

V. Phone/Fax

Practice location:
  • Phone: 812-933-6220
  • Fax:
Mailing address:
  • Phone: 812-933-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03229882
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26023294A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: