Provider Demographics
NPI:1124329792
Name:FERGUSON, DAVID ALAN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
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 1:3011 VINTAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:907-523-2060
Mailing Address - Fax:907-523-2019
Practice Address - Street 1:3033 VINTAGE AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:907-523-2060
Practice Address - Fax:907-523-2019
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist