Healthcare Provider Details

I. General information

NPI: 1306202288
Provider Name (Legal Business Name): SUSAN MOUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

IV. Provider business mailing address

1029 HIGHWAY KK
TROY MO
63379-5065
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-2273
  • Fax:
Mailing address:
  • Phone: 636-528-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40744
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: