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NPI Code Detail

MEDICARE: DR. IVAN E FERGUSON JR. PHARMD

MEDICARE: DR. IVAN E FERGUSON JR. 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
1183500000XPharmacist042199MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952686107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IVAN E FERGUSON JR. PHARMD
Provider Business Mailing Address
First Line : 4630 TROOST AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64110-1712
Country : US
Telephone Number : 816-931-8337
Fax Number : 816-931-4980
Provider Business Practice Location Address
First Line : 2630 NE VIVION ROAD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64119-2513
Country : US
Telephone Number : 816-459-7175
Fax Number : 816-459-7686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 08/13/2020

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