Healthcare Provider Details

I. General information

NPI: 1053906628
Provider Name (Legal Business Name): SUSAN ANN LINGENFELTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 W MAIN ST STE 106
SALEM VA
24153-2073
US

IV. Provider business mailing address

3737 W MAIN ST STE 106
SALEM VA
24153-2073
US

V. Phone/Fax

Practice location:
  • Phone: 540-380-2940
  • Fax: 540-444-7321
Mailing address:
  • Phone: 540-380-2940
  • Fax: 540-444-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202206014
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: