Healthcare Provider Details

I. General information

NPI: 1316276033
Provider Name (Legal Business Name): SUSAN CHRISTINE FAGAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HM 1220 1120 15TH STREET UNIVERSITY OF GEORGIA COLLEGE OF PHARMACY
AUGUSTA GA
30912
US

IV. Provider business mailing address

107 BLACKHAW DR
NORTH AUGUSTA SC
29860-9218
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4915
  • Fax: 706-721-3994
Mailing address:
  • Phone: 706-721-4915
  • Fax: 706-721-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH020270
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: