1548470875 NPI number — DR. SUSAN RICHARD TEGTMEIER PHARM.D.

Table of content: DR. SUSAN RICHARD TEGTMEIER PHARM.D. (NPI 1548470875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548470875 NPI number — DR. SUSAN RICHARD TEGTMEIER PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEGTMEIER
Provider First Name:
SUSAN
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TEGTMEIER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
RICHARD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548470875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 SHADY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40503-2032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-6106
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3349 TATES CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40502-3467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-266-0413
Provider Business Practice Location Address Fax Number:
859-266-6463
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  10182 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10182 . This is a "LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com