Healthcare Provider Details

I. General information

NPI: 1548488133
Provider Name (Legal Business Name): WILLIAM J FARRELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 DIXIE HWY
ERLANGER KY
41018-1827
US

IV. Provider business mailing address

79 SUNNYMEDE DR
FT MITCHELL KY
41017-2816
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-0342
  • Fax:
Mailing address:
  • Phone: 859-341-5622
  • Fax: 859-292-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007093
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: