Provider Demographics
NPI:1902174063
Name:FARLEY, VONCILLE W (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VONCILLE
Middle Name:W
Last Name:FARLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 SW WAGGONER HOPKINS DR
Mailing Address - Street 2:PO BOX 5
Mailing Address - City:KINGSTON
Mailing Address - State:MO
Mailing Address - Zip Code:64650
Mailing Address - Country:US
Mailing Address - Phone:816-586-2056
Mailing Address - Fax:
Practice Address - Street 1:3620 SW WAGGONER HOPKINS DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MO
Practice Address - Zip Code:64650
Practice Address - Country:US
Practice Address - Phone:816-586-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010150621835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist