MEDICARE: DR. MINDY FERGUSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03136213	OH

General Provider Information

NPI Number	:	1356892186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINDY FERGUSON PHARMD

Provider Business Mailing Address
First Line	:	1542 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1708
Country	:	US
Telephone Number	:	937-254-2156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	10/17/2016

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