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General NPI Number Information
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NPI Number | 1720688302
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Entity Type | Individual
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Provider Name | KARL EDWARD FERRY RPH
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Gender | Male
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 961 N MARKET ST
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City | WATERLOO
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State | IL
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Zip | 62298-1080
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Country | US
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Telephone | 618-939-4088
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Fax | 618-939-3419
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Provider Business Mailing Address
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Address Line | 6055 KONARCIK RD
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City | WATERLOO
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State | IL
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Zip | 62298-2413
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Country | US
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Telephone | 618-444-9177
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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 | 051.039872
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License Number State | IL
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