Provider Demographics
NPI:1144241811
Name:TIGERT, SUSAN LOUISE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LOUISE
Last Name:TIGERT
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1159
Mailing Address - Country:US
Mailing Address - Phone:580-226-0509
Mailing Address - Fax:
Practice Address - Street 1:35 TIFFANY PLZ STE C
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2526
Practice Address - Country:US
Practice Address - Phone:580-223-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist