Provider Demographics
NPI:1053906628
Name:LINGENFELTER, SUSAN ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 W MAIN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2073
Mailing Address - Country:US
Mailing Address - Phone:540-380-2940
Mailing Address - Fax:540-444-7321
Practice Address - Street 1:3737 W MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-2073
Practice Address - Country:US
Practice Address - Phone:540-380-2940
Practice Address - Fax:540-444-7321
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022060141835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care