Active NPI
Susanne Lane Maxwell, RPH
- Pharmacist
- Statesboro, GA
National Provider Identifier
1669825691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH16900
- Practice address
- 22 S Zetterower Ave
Statesboro, GA 30458-4866 - Phone
- (912) 764-6454
- Fax
- (912) 489-1110
- NPI assigned
- Jul 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH16900 | GA | Primary |
Addresses
Primary practice location
22 S Zetterower Ave
Statesboro, GA 30458-4866
Mailing address
22 S Zetterower Ave
Statesboro, GA 30458-4866
Phone (912) 764-6454
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
| License | State | Type | Specialty |
|---|---|---|---|
| RPH16900 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Town and Campus Retailers, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Statesboro, GA
- NPI 1063407807
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468454400000",
"number": "1669825691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 S ZETTEROWER AVE",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304584866",
"telephone_number": "912-764-6454",
"fax_number": "912-489-1110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 S ZETTEROWER AVE",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304584866",
"telephone_number": "912-764-6454",
"fax_number": "912-489-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXWELL",
"first_name": "SUSANNE",
"middle_name": "LANE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-14",
"last_updated": "2016-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH16900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.