Healthcare Provider Details

I. General information

NPI: 1104217116
Provider Name (Legal Business Name): CHRISTEN FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 TAYLORSVILLE RD
LOUISVILLE KY
40220-3530
US

IV. Provider business mailing address

4640 TAYLORSVILLE RD
LOUISVILLE KY
40220-3530
US

V. Phone/Fax

Practice location:
  • Phone: 502-493-2732
  • Fax:
Mailing address:
  • Phone: 502-493-2732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00029868
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: