Susan Edsall
Individual provider Active NPI Pharmacist · Canton, OK
NPI 1609289453 · NPPES record last updated Jun 10, 2014
Key facts
- NPI
- 1609289453
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 11930 (OK)
- Practice address
- 411 E Oak
Canton, OK 73724 - Phone
- (580) 886-4323
- Fax
- (580) 886-2652
- NPI assigned
- Jun 10, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11930 | OK | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11930 | OK | Yes |
Addresses
Primary practice location
411 E Oak
Canton, OK 73724
Mailing address
PO Box 811
Canton, OK 73724-0811
Phone (580) 886-4323
Other providers in Canton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.