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General NPI Number Information
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NPI Number | 1467789214
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Entity Type | Individual
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Provider Name | SUSAN FRANK MACIVOR
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Gender | Female
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 1413 WIRT RD
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City | HOUSTON
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State | TX
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Zip | 77055-4916
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Country | US
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Telephone | 713-467-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 715 CHERRYBARK LN
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City | HOUSTON
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State | TX
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Zip | 77079-3701
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Country | US
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Telephone | 713-932-8281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35922
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License Number State | TX
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