Provider Demographics
NPI:1316276033
Name:FAGAN, SUSAN CHRISTINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:FAGAN
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 1:107 BLACKHAW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9218
Mailing Address - Country:US
Mailing Address - Phone:706-721-4915
Mailing Address - Fax:706-721-3994
Practice Address - Street 1:HM 1220 1120 15TH STREET
Practice Address - Street 2:UNIVERSITY OF GEORGIA COLLEGE OF PHARMACY
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-4915
Practice Address - Fax:706-721-3994
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0202701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist