Provider Demographics
NPI:1427333483
Name:TEGART, SUSAN
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:TEGART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3610 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2212
Mailing Address - Country:US
Mailing Address - Phone:619-280-5514
Mailing Address - Fax:619-280-4975
Practice Address - Street 1:3610 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2212
Practice Address - Country:US
Practice Address - Phone:619-280-5514
Practice Address - Fax:619-280-4975
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH56119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist