1265032965 NPI number — MRS. SUSAN RAYLETTE BARTON RPH.

Table of content: MRS. SUSAN RAYLETTE BARTON RPH. (NPI 1265032965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265032965 NPI number — MRS. SUSAN RAYLETTE BARTON RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTON
Provider First Name:
SUSAN
Provider Middle Name:
RAYLETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTON
Provider Other First Name:
RAYLETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265032965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 HIGHWAY K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63366-5978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-980-9300
Provider Business Mailing Address Fax Number:
636-978-8447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 HIGHWAY K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-5978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-980-9300
Provider Business Practice Location Address Fax Number:
636-978-8447
Provider Enumeration Date:
10/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  044905 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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