MEDICARE: KELLY FERGUSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26020143A	IN

General Provider Information

NPI Number	:	1043591068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY FERGUSON PHARMD

Provider Business Mailing Address
First Line	:	9 N STATE ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1723
Country	:	US
Telephone Number	:	812-346-4834
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 N STATE ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-1723
Country	:	US
Telephone Number	:	812-346-4834
Fax Number	:	812-346-7058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2011
Last Update Date	:	09/03/2011

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Directions to “ KELLY FERGUSON PHARMD” Practice Location

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