Provider Demographics
NPI:1790923936
Name:FERGUSON, ANNA F (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:F
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 1:24 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6524
Mailing Address - Country:US
Mailing Address - Phone:828-632-8591
Mailing Address - Fax:828-635-0529
Practice Address - Street 1:24 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-6524
Practice Address - Country:US
Practice Address - Phone:828-632-8591
Practice Address - Fax:828-635-0529
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102693336C0003X
NC9028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC025064Medicaid
NC025064Medicaid