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NPI Code Detail

MEDICARE: DEBRA DIANE FERGESON B.S.

MEDICARE: DEBRA DIANE FERGESON B.S.
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
1183500000XPharmacist5302025652MI

General Provider Information

NPI Number : 1265449698
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA DIANE FERGESON B.S.
Provider Business Mailing Address
First Line : 847 S KALAMAZOO ST
Second Line :
City : PAW PAW
State : MI
Zip : 49079-9230
Country : US
Telephone Number : 269-657-1778
Fax Number : 269-657-1779
Provider Business Practice Location Address
First Line : 847 S KALAMAZOO ST
Second Line :
City : PAW PAW
State : MI
Zip : 49079-9230
Country : US
Telephone Number : 269-657-7118
Fax Number : 269-657-1779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 09/12/2007

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