Provider Demographics
NPI:1164913265
Name:FERGUSON, CLAIRE NICOLE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:NICOLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2502
Mailing Address - Country:US
Mailing Address - Phone:661-823-7094
Mailing Address - Fax:661-823-7096
Practice Address - Street 1:775 TUCKER RD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2502
Practice Address - Country:US
Practice Address - Phone:661-823-7094
Practice Address - Fax:661-823-7096
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist