Healthcare Provider Details

I. General information

NPI: 1831171123
Provider Name (Legal Business Name): SUSAN J HILLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 S ELLIS ST
WICHITA KS
67211-1812
US

IV. Provider business mailing address

12800 W 87TH ST S
CLEARWATER KS
67026-8927
US

V. Phone/Fax

Practice location:
  • Phone: 316-265-3300
  • Fax: 316-265-3304
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-10748
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: