Provider Demographics
NPI:1548488133
Name:FARRELL, WILLIAM J (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:FARRELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SUNNYMEDE DR
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2816
Mailing Address - Country:US
Mailing Address - Phone:859-341-5622
Mailing Address - Fax:859-292-2873
Practice Address - Street 1:3104 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1827
Practice Address - Country:US
Practice Address - Phone:859-426-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist