Provider Demographics
NPI:1740267327
Name:FERGUSON, BRIEN PETER
Entity type:Individual
Prefix:
First Name:BRIEN
Middle Name:PETER
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18032 36TH AVE W
Mailing Address - Street 2:#N12
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-3861
Mailing Address - Country:US
Mailing Address - Phone:425-387-7086
Mailing Address - Fax:
Practice Address - Street 1:8862 161ST AVENUE SE
Practice Address - Street 2:#102
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-883-9532
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00045228183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician