Provider Demographics
NPI:1548470875
Name:TEGTMEIER, SUSAN RICHARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RICHARD
Last Name:TEGTMEIER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:RICHARD
Other - Last Name:TEGTMEIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:107 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2032
Mailing Address - Country:US
Mailing Address - Phone:859-278-6106
Mailing Address - Fax:
Practice Address - Street 1:3349 TATES CREEK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3467
Practice Address - Country:US
Practice Address - Phone:859-266-0413
Practice Address - Fax:859-266-6463
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10182OtherLICENSE