MEDICARE: MRS. SUSAN GAINEY FERGUSON R.PH.

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
1	183500000X	Pharmacist	32227	TX

General Provider Information

NPI Number	:	1821004953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN GAINEY FERGUSON R.PH.

Provider Business Mailing Address
First Line	:	5145 FM 620 N STE A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1818
Country	:	US
Telephone Number	:
Fax Number	:	512-417-3631

Provider Business Practice Location Address
First Line	:	5145 FM 620 N
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78732-1815
Country	:	US
Telephone Number	:	512-266-1392
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/22/2025

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