Individual
MR. GREG CLARKE FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH RN
Contact information
Practice address
4522 SE LINCOLN ST, PORTLAND, OR 97215-3744
(503) 816-5421
(503) 816-5421
Mailing address
4522 SE LINCOLN ST, PORTLAND, OR 97215-3744
(503) 816-5421
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
094000338
OR
183500000X
Pharmacist
8139
OR
Other
Enumeration date
03/10/2012
Last updated
09/28/2012
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