Healthcare Provider Details

I. General information

NPI: 1366645343
Provider Name (Legal Business Name): FERGUSON DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAIN ST
WILLOW SPRINGS MO
65793-1413
US

IV. Provider business mailing address

101 E MAIN ST P.O. BOX 278
WILLOW SPRINGS MO
65793-1413
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-3005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEVE NORMAN
Title or Position: OWNER PHARMACIST
Credential:
Phone: 417-469-3005