Healthcare Provider Details

I. General information

NPI: 1407189095
Provider Name (Legal Business Name): ERIC KENNETH FARMER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE SUITE 700
INDIANAPOLIS IN
46202-1261
US

IV. Provider business mailing address

1633 N CAPITOL AVE SUITE 700
INDIANAPOLIS IN
46202-1261
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-5159
  • Fax: 317-963-5039
Mailing address:
  • Phone: 317-962-5159
  • Fax: 317-963-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26022515A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: