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General NPI Number Information
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NPI Number | 1316675655
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Entity Type | Individual
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Provider Name | JACOB MICHAEL FERGUSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2022
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Last Update Date | 08/14/2022
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Provider Practice Location Address
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Address Line | 176 VIRGINIA AVE FL 3
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City | ROCHESTER
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State | PA
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Zip | 15074-1723
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Country | US
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Telephone | 724-987-6085
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ELIZABETH DR APT 3301
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City | PITTSBURGH
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State | PA
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Zip | 15220-3337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP452407
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License Number State | PA
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