Active NPI
Susan Anne Middendorf
- Pharmacist
- Maumee, OH
National Provider Identifier
1962917344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03321779
- Practice address
- 1435 Reynolds Rd
Maumee, OH 43537-1625 - Phone
- (567) 302-2689
- Fax
- (567) 302-2691
- NPI assigned
- Dec 7, 2017
- Sex
- Female
- Sole proprietor
- No
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 | 03321779 | OH | Primary |
Addresses
Primary practice location
1435 Reynolds Rd
Maumee, OH 43537-1625
Mailing address
224 E Dudley St
Maumee, OH 43537-3316
Phone (419) 509-2520
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03321779 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co | Past | Accepting new patients | |
| The Kroger Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512604800000",
"number": "1962917344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "224 E DUDLEY ST",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435373316",
"telephone_number": "419-509-2520",
"fax_number": "567-302-2691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1435 REYNOLDS RD",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435371625",
"telephone_number": "567-302-2689",
"fax_number": "567-302-2691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDENDORF",
"first_name": "SUSAN",
"middle_name": "ANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-07",
"last_updated": "2017-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03321779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
- David M Merrell, M.D.
- Carrie Sue Mersereau, CNP
- Garima Methi
- Gretchen Meyer
- Jill Michalak
- Midwest Detox Center LLC (Ohio Detox Center)
- Midwest Detox Center LLC (Ohio Detox Center)
- Midwest Detox Center LLC (Ohio Detox Center, LLC)
- Midwest Direct Mobile Dental, Taiwo Ngo LLC
- Midwest Eye Consultants Ohio, Inc (Cataract & Laser Institute ASC - Maumee #352)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.