Healthcare Provider Details

I. General information

NPI: 1497561278
Provider Name (Legal Business Name): NADIA FERGUSON-MYRTHIL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADIA FERGUSON PHARMD

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 12/06/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST 211TH STREET PHARMACY DEPARTMENT
BRONX NY
10467-1046
US

IV. Provider business mailing address

4372 WILDER AVE PH
BRONX NY
10466-1824
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4243
  • Fax:
Mailing address:
  • Phone: 718-757-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number049817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: