MEDICARE: SUSAN CAROL STRICKLAND RPH

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	RPH017385	GA
2	183500000X	Pharmacist	0000009281	TN

General Provider Information

NPI Number	:	1689928285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CAROL STRICKLAND RPH

Provider Business Mailing Address
First Line	:	526 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3849
Country	:	US
Telephone Number	:	706-861-2771
Fax Number	:	706-866-5195

Provider Business Practice Location Address
First Line	:	526 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3849
Country	:	US
Telephone Number	:	706-861-2771
Fax Number	:	706-866-5195

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

Provider Enumeration Date	:	11/04/2012
Last Update Date	:	11/04/2012

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