Provider Demographics
NPI:1013191030
Name:FERGUSON, AMBER LORRAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LORRAINE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-6211
Mailing Address - Country:US
Mailing Address - Phone:315-736-6822
Mailing Address - Fax:
Practice Address - Street 1:4765 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-6211
Practice Address - Country:US
Practice Address - Phone:315-736-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440247183500000X
NJ28RI03075600183500000X
NY049206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03075600OtherNJ PHARMACY LICENSE
NY049206OtherNY STATE PHARMACY LICENSE
PARP440247OtherPA PHARMACY LICENSE