Individual
MRS. SUSAN MARIE KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
3330 MARTIN LUTHER KING JR PKWY, DES MOINES, IA 50310-5672
(515) 255-6213
(515) 255-8806
Mailing address
14961 SUMMIT DR, CLIVE, IA 50325-7820
(515) 987-2172
(515) 255-8806
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
17764
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0233916
—
IA
01
—
1614571
NABP
IA
01
—
IA17764
PHARMACIST LICENSE
IA
Enumeration date
05/12/2007
Last updated
07/08/2007
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