Basic Information
| Provider Information | |||||||||
| NPI: | 1033556816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRESTON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2557 | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315342557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123841898 | ||||||||
| FaxNumber: | 9123837109 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 PETERSON AVE S | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315335237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123841898 | ||||||||
| FaxNumber: | 9123837109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH017755 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.