Provider Demographics
NPI:1619233376
Name:FERGUSON, KAREN ADKINS (RPH)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ADKINS
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 1:3230 SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:CENTRAL LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49622-9252
Mailing Address - Country:US
Mailing Address - Phone:231-676-3432
Mailing Address - Fax:
Practice Address - Street 1:3230 SUNSET TER
Practice Address - Street 2:
Practice Address - City:CENTRAL LAKE
Practice Address - State:MI
Practice Address - Zip Code:49622-9252
Practice Address - Country:US
Practice Address - Phone:231-676-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410970183500000X
FLPS23840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist