Healthcare Provider Details

I. General information

NPI: 1568574614
Provider Name (Legal Business Name): JAN FARMER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 CLEVELAND
GREAT BEND KS
67530
US

IV. Provider business mailing address

541 CLEVELAND
GREAT BEND KS
67530
US

V. Phone/Fax

Practice location:
  • Phone: 620-791-6283
  • Fax:
Mailing address:
  • Phone: 620-791-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1021
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10909
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23541
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19302
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: