Provider Demographics
NPI:1730748039
Name:WINSLOW, SUSAN KAY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 N SUMMERS RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-8826
Mailing Address - Country:US
Mailing Address - Phone:810-724-4630
Mailing Address - Fax:
Practice Address - Street 1:555 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4611
Practice Address - Country:US
Practice Address - Phone:810-664-8360
Practice Address - Fax:810-664-8705
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315106522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty