1467762252 NPI number — DR. SUSAN LEABERRY VICTOR PHARMD

Table of content: DR. SUSAN LEABERRY VICTOR PHARMD (NPI 1467762252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467762252 NPI number — DR. SUSAN LEABERRY VICTOR PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICTOR
Provider First Name:
SUSAN
Provider Middle Name:
LEABERRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467762252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 MEDICAL CIR
Provider Second Line Business Mailing Address:
PHARMACY
Provider Business Mailing Address City Name:
MOREHEAD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40351-1179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-784-3674
Provider Business Mailing Address Fax Number:
606-783-6693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 MEDICAL CIR
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-3674
Provider Business Practice Location Address Fax Number:
606-783-6693
Provider Enumeration Date:
10/14/2010

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:  007307 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RP0003060 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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