Provider Demographics
NPI:1417686783
Name:FERGUSON, CATHERINE TRACY (RPH)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:TRACY
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 1:42 RED FOX TRL
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-3710
Mailing Address - Country:US
Mailing Address - Phone:126-797-2524
Mailing Address - Fax:
Practice Address - Street 1:42 RED FOX TRL
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-3710
Practice Address - Country:US
Practice Address - Phone:267-972-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI027888001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist