Healthcare Provider Details

I. General information

NPI: 1275946824
Provider Name (Legal Business Name): JAMES FARLEY II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 HIGHLANDER POINT DR
FLOYDS KNOBS IN
47119-9470
US

IV. Provider business mailing address

329 SPRING LAKE CT
LOUISVILLE KY
40229-4476
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-8829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26024651A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number016049
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: