Healthcare Provider Details

I. General information

NPI: 1316927676
Provider Name (Legal Business Name): SUSAN ELAINE FUGATE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 NW 56TH ST SUITE 140B
OKLAHOMA CITY OK
73112-4455
US

IV. Provider business mailing address

16104 CANTERA CREEK DR
EDMOND OK
73013-1473
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-8369
  • Fax: 405-951-8376
Mailing address:
  • Phone: 405-706-9022
  • Fax: 405-951-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12343
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: