Provider Demographics
NPI:1821004953
Name:FERGUSON, SUSAN GAINEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GAINEY
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LAKEWAY DR APT C
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4453
Mailing Address - Country:US
Mailing Address - Phone:512-417-3631
Mailing Address - Fax:512-417-3631
Practice Address - Street 1:1101 LAKEWAY DR APT C
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4453
Practice Address - Country:US
Practice Address - Phone:512-417-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist