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General NPI Number Information
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NPI Number | 1518562586
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Entity Type | Individual
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Provider Name | SUSAN TSAGRIS
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Gender | Female
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 3240 WILLOWCREEK RD
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City | PORTAGE
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State | IN
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Zip | 46368-5055
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Country | US
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Telephone | 219-762-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 272 KINCRAIG DR
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City | VALPARAISO
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State | IN
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Zip | 46385-9299
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Country | US
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Telephone | 219-617-4483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 26019263A
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License Number State | IN
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