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General NPI Number Information
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NPI Number | 1962917344
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Entity Type | Individual
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Provider Name | SUSAN ANNE MIDDENDORF
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Gender | Female
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 12/07/2017
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Provider Practice Location Address
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Address Line | 1435 REYNOLDS RD
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City | MAUMEE
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State | OH
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Zip | 43537-1625
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Country | US
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Telephone | 567-302-2689
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Fax | 567-302-2691
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Provider Business Mailing Address
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Address Line | 224 E DUDLEY ST
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City | MAUMEE
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State | OH
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Zip | 43537-3316
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Country | US
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Telephone | 419-509-2520
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Fax | 567-302-2691
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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 | 03321779
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License Number State | OH
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