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NPI Code Detail

MEDICARE: DR. SUSAN RICHARD TEGTMEIER PHARM.D.

MEDICARE:  DR. SUSAN RICHARD TEGTMEIER  PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist10182KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110182OTHERKYLICENSE

General Provider Information

NPI Number : 1548470875
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN RICHARD TEGTMEIER PHARM.D.
Provider Business Mailing Address
First Line : 107 SHADY LN
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-2032
Country : US
Telephone Number : 859-278-6106
Fax Number :
Provider Business Practice Location Address
First Line : 3349 TATES CREEK RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-3467
Country : US
Telephone Number : 859-266-0413
Fax Number : 859-266-6463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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