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General NPI Number Information
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NPI Number | 1568453280
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Entity Type | Organization
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Legal Business Name | SUSAN ENTERPRISES
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 124 7TH ST SW
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City | CULLMAN
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State | AL
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Zip | 35055-4262
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Country | US
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Telephone | 256-734-4933
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Fax | 256-734-2304
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Provider Business Mailing Address
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Address Line | 124 7TH ST SW
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City | CULLMAN
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State | AL
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Zip | 35055-4262
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Country | US
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Telephone | 256-734-4933
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Fax | 256-734-2304
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Authorized Official
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Title or Position | PHARMACIST OWNER
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Name | MS. SUSAN ADKISON
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Credential | RPH
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Telephone | 256-734-4933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 110549
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License Number State | AL
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