MEDICARE: MRS. SUSAN ELIZABETH FEHR R.PH.

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	183500000X	Pharmacist	5302024106	MI

General Provider Information

NPI Number	:	1548252034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN ELIZABETH FEHR R.PH.

Provider Business Mailing Address
First Line	:	1977 LAGOON DR
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-2106
Country	:	US
Telephone Number	:	517-349-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W GREENLAWN AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-2819
Country	:	US
Telephone Number	:	517-334-2432
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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