Provider Demographics
NPI:1538763073
Name:FERGUSON, KEILAH (PHARMD)
Entity type:Individual
Prefix:
First Name:KEILAH
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 WESLEY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-7558
Mailing Address - Country:US
Mailing Address - Phone:931-242-2455
Mailing Address - Fax:
Practice Address - Street 1:1002 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35633-1636
Practice Address - Country:US
Practice Address - Phone:256-766-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39311183500000X
AL18719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist