MEDICARE: MR. MIGUEL D. FERGUSON PHARM.D., R.PH.

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	PS37091	FL

General Provider Information

NPI Number	:	1457448458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL D. FERGUSON PHARM.D., R.PH.

Provider Business Mailing Address
First Line	:	1537 NW SAINT LUCIE WEST BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2113
Country	:	US
Telephone Number	:	772-340-4350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 NW SAINT LUCIE WEST BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2113
Country	:	US
Telephone Number	:	772-340-4350
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/03/2024

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