Provider Demographics
NPI:1841693967
Name:FERGUSON, PATRICK JR
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:FERGUSON
Suffix:JR
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 1:1128 WILLIAMSBURG PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3731
Mailing Address - Country:US
Mailing Address - Phone:785-842-2434
Mailing Address - Fax:785-832-6832
Practice Address - Street 1:1128 WILLIAMSBURG PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3731
Practice Address - Country:US
Practice Address - Phone:785-842-2434
Practice Address - Fax:785-832-6832
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist