Provider Demographics
NPI:1053605170
Name:MORROW, SUSAN NICHOLE (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:NICHOLE
Last Name:MORROW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6625 E LLOYD EXPY
Mailing Address - Street 2:T-1481
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2757
Mailing Address - Country:US
Mailing Address - Phone:812-402-8509
Mailing Address - Fax:812-402-8509
Practice Address - Street 1:6625 E LLOYD EXPY
Practice Address - Street 2:T-1481
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2757
Practice Address - Country:US
Practice Address - Phone:812-402-8509
Practice Address - Fax:812-402-8509
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019983A183500000X
FLPS31609183500000X
KY013503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist