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NPI Code Detail

MEDICARE: SUSAN MOUNT

MEDICARE: SUSAN MOUNT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist40744MO

General Provider Information

NPI Number : 1306202288
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MOUNT
Provider Business Mailing Address
First Line : 1029 HIGHWAY KK
Second Line :
City : TROY
State : MO
Zip : 63379-5065
Country : US
Telephone Number : 636-528-4510
Fax Number :
Provider Business Practice Location Address
First Line : 806 N STURGEON ST
Second Line :
City : MONTGOMERY CITY
State : MO
Zip : 63361-1426
Country : US
Telephone Number : 573-564-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2016
Last Update Date : 01/08/2016

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Directions to “ SUSAN MOUNT ” Practice Location

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