Individual
BREANNA PAIGE FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
515 N 12TH ST, MIDDLESBORO, KY 40965-1131
(606) 248-2093
Mailing address
PO BOX 451, FLAT LICK, KY 40935-0451
(606) 499-5170
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
022805
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F11-121-310
DRIVERS LICENSE
KY
Enumeration date
08/09/2022
Last updated
08/09/2022
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