Individual provider Active NPI

Susan P Wilson, RPH

  • Pharmacist
  • Kennewick, WA
National Provider Identifier
1346513439
Registry record updated Feb 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH00053582 Issued in WA
Practice address
2811 W 10TH Ave
Kennewick, WA 99336-3104
Phone
(509) 735-8733
Fax
(509) 735-8727
NPI assigned
Feb 20, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH00053582 WA Primary

Addresses

Primary practice location

2811 W 10TH Ave
Kennewick, WA 99336-3104

Mailing address

2811 W 10TH Ave
Kennewick, WA 99336-3104
Phone (509) 735-8733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PH00053582WAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329696000000",
    "number": "1346513439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 W 10TH AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993363104",
            "telephone_number": "509-735-8733",
            "fax_number": "509-735-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 W 10TH AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993363104",
            "telephone_number": "509-735-8733",
            "fax_number": "509-735-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SUSAN",
        "middle_name": "P",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-20",
        "last_updated": "2012-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00053582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.