Provider Demographics
NPI:1134262603
Name:FERGESON, CARYEN LEEMARIE (RPH)
Entity type:Individual
Prefix:
First Name:CARYEN
Middle Name:LEEMARIE
Last Name:FERGESON
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 1:1025 W COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-4709
Mailing Address - Country:US
Mailing Address - Phone:580-363-2178
Mailing Address - Fax:580-363-5582
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-2226
Practice Address - Country:US
Practice Address - Phone:580-363-2137
Practice Address - Fax:580-363-5582
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist