Provider Demographics
NPI:1497561278
Name:FERGUSON-MYRTHIL, NADIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NADIA
Middle Name:
Last Name:FERGUSON-MYRTHIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4372 WILDER AVE PH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1824
Mailing Address - Country:US
Mailing Address - Phone:718-757-5307
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 211TH STREET
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1046
Practice Address - Country:US
Practice Address - Phone:718-920-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0498171835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care