Provider Demographics
NPI:1992079065
Name:FEINGOLD, SUE (RPH)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:FEINGOLD
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 1:2212 CEDAR ELM TER
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9027
Mailing Address - Country:US
Mailing Address - Phone:817-366-6646
Mailing Address - Fax:817-431-3938
Practice Address - Street 1:2212 CEDAR ELM TER
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-9027
Practice Address - Country:US
Practice Address - Phone:817-366-6646
Practice Address - Fax:817-431-3938
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist