Provider Demographics
NPI:1871898353
Name:FERGUSON, KIMBERLY A (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
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 1:479 DELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2907
Mailing Address - Country:US
Mailing Address - Phone:828-452-2313
Mailing Address - Fax:828-452-5451
Practice Address - Street 1:479 DELLWOOD RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2907
Practice Address - Country:US
Practice Address - Phone:828-452-2313
Practice Address - Fax:828-452-5451
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11074OtherNC BOARD OF PHARMACY