Individual
SUSANNAH SPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1440 S FOREST AVE, LUVERNE, AL 36049-7330
(334) 335-5888
Mailing address
PO BOX 126, BRANTLEY, AL 36009-0126
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21522
AL
Other
Enumeration date
08/19/2020
Last updated
08/19/2020
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