Provider Demographics
NPI:1851095723
Name:ANTAR, SUSAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:ANTAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 E 87TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2836
Mailing Address - Country:US
Mailing Address - Phone:203-812-0830
Mailing Address - Fax:
Practice Address - Street 1:9122 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4039
Practice Address - Country:US
Practice Address - Phone:918-494-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist