MEDICARE: SUSAN DIANE WEST PHARMD

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
1	1835P1200X	Pharmacotherapy Pharmacist	7104	KY
2	1835P1200X	Pharmacotherapy Pharmacist	26091584A	IN
3	1835P1200X	Pharmacotherapy Pharmacist	9215	TN

General Provider Information

NPI Number	:	1336140532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DIANE WEST PHARMD

Provider Business Mailing Address
First Line	:	990 SPORTSMAN CLUB LN
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-9256
Country	:	US
Telephone Number	:	270-726-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 SPORTSMAN CLUB LN
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-9256
Country	:	US
Telephone Number	:	270-726-9010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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Directions to “ SUSAN DIANE WEST PHARMD” Practice Location

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