Healthcare Provider Details

I. General information

NPI: 1376825844
Provider Name (Legal Business Name): SUSAN KAPTUR RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W GLEN PARK AVE
GRIFFITH IN
46319-1511
US

IV. Provider business mailing address

1835 ROSEWOOD LN
MUNSTER IN
46321-5148
US

V. Phone/Fax

Practice location:
  • Phone: 219-924-2701
  • Fax: 219-924-8691
Mailing address:
  • Phone: 219-934-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26016060A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: