Provider Demographics
NPI:1265449698
Name:FERGESON, DEBRA DIANE (BS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANE
Last Name:FERGESON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 S KALAMAZOO ST
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9230
Mailing Address - Country:US
Mailing Address - Phone:269-657-1778
Mailing Address - Fax:269-657-1779
Practice Address - Street 1:847 S KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9230
Practice Address - Country:US
Practice Address - Phone:269-657-7118
Practice Address - Fax:269-657-1779
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist