Healthcare Provider Details

I. General information

NPI: 1376540690
Provider Name (Legal Business Name): ROBERT BRUCE FERGUSON PHARM.D. BCPP, MHS,
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

PO BOX 13704
CHARLESTON SC
29422-3704
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7834
  • Fax:
Mailing address:
  • Phone: 843-406-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number7649
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: