Provider Demographics
NPI:1548872484
Name:FERGUSON, LINDSAY KRAVCHUK (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KRAVCHUK
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ELIZABETH
Other - Last Name:KRAVCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1008 AUDUBON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2606
Mailing Address - Country:US
Mailing Address - Phone:337-764-0348
Mailing Address - Fax:
Practice Address - Street 1:1350 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-3727
Practice Address - Country:US
Practice Address - Phone:409-769-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist