Provider Demographics
NPI:1124321518
Name:FERGUSON, THERESA LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LYNN
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 1:749 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9280
Mailing Address - Country:US
Mailing Address - Phone:336-246-9111
Mailing Address - Fax:336-246-3656
Practice Address - Street 1:749 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9280
Practice Address - Country:US
Practice Address - Phone:336-246-9111
Practice Address - Fax:336-246-3656
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist