Provider Demographics
NPI:1275853780
Name:FERGUSON, CHARLOTTE E
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:E
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 1:4430 DATE AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6415
Mailing Address - Country:US
Mailing Address - Phone:619-991-7018
Mailing Address - Fax:800-824-2933
Practice Address - Street 1:7283 ENGINEER RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1414
Practice Address - Country:US
Practice Address - Phone:858-598-5600
Practice Address - Fax:858-598-5619
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist