Active NPI
Susan M Pennell, RPH CCN
- Nutrition Support Pharmacist
- Flint, MI
National Provider Identifier
1861571564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Support Pharmacist
- License
- 023789
- Practice address
- G3320 Beecher Rd
Flint, MI 48532-3614 - Phone
- (810) 732-8720
- Fax
- (810) 732-6267
- NPI assigned
- Nov 3, 2006
- 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 |
|---|---|---|---|---|
| Nutrition Support Pharmacist | 1835N1003X | 023789 | MI | Primary |
Addresses
Primary practice location
G3320 Beecher Rd
Flint, MI 48532-3614
Mailing address
2262 N McKinley Rd
Flushing, MI 48433-9420
Phone (810) 487-0503
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 |
|---|---|---|---|
| 023789 | MI | MD | Nutrition Support Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861571564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2262 N MCKINLEY RD",
"city": "FLUSHING",
"state": "MI",
"postal_code": "484339420",
"telephone_number": "810-487-0503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "G3320 BEECHER RD",
"city": "FLINT",
"state": "MI",
"postal_code": "485323614",
"telephone_number": "810-732-8720",
"fax_number": "810-732-6267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNELL",
"first_name": "SUSAN",
"middle_name": "M",
"credential": "RPH CCN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "MI",
"license": "023789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.