Provider Demographics
NPI:1487955035
Name:GOULD, SUSAN MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:GOULD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 N HIGHWAY 183
Mailing Address - Street 2:
Mailing Address - City:MAY
Mailing Address - State:TX
Mailing Address - Zip Code:76857-2919
Mailing Address - Country:US
Mailing Address - Phone:503-679-9248
Mailing Address - Fax:
Practice Address - Street 1:2701 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5834
Practice Address - Country:US
Practice Address - Phone:325-646-1100
Practice Address - Fax:325-646-1104
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9136183500000X
TX54444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist