MEDICARE: MRS. CHARLOTTE E FERGUSON

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	60826	CA

General Provider Information

NPI Number	:	1275853780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE E FERGUSON

Provider Business Mailing Address
First Line	:	4430 DATE AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-6415
Country	:	US
Telephone Number	:	619-991-7018
Fax Number	:	800-824-2933

Provider Business Practice Location Address
First Line	:	7283 ENGINEER RD STE D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1414
Country	:	US
Telephone Number	:	858-598-5600
Fax Number	:	858-598-5619

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	12/28/2020

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