Provider Demographics
NPI:1538300363
Name:STILWELL, SUSAN MARIE (RPH)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:STILWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ROSIEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355
Mailing Address - Country:US
Mailing Address - Phone:541-259-1225
Mailing Address - Fax:
Practice Address - Street 1:185 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355
Practice Address - Country:US
Practice Address - Phone:541-259-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009677P1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist