Healthcare Provider Details

I. General information

NPI: 1699175182
Provider Name (Legal Business Name): BENJAMIN FERGUSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 SE FEDERAL HWY
STUART FL
34994-5531
US

IV. Provider business mailing address

7589 SE TETON DR
HOBE SOUND FL
33455-7884
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-6468
  • Fax:
Mailing address:
  • Phone: 772-285-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: