Healthcare Provider Details

I. General information

NPI: 1437364452
Provider Name (Legal Business Name): MICHAEL EDWARD FARRELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELM ST
LUDLOW KY
41016-1450
US

IV. Provider business mailing address

524 GARRARD ST APT 3
COVINGTON KY
41011-4206
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-2210
  • Fax:
Mailing address:
  • Phone: 859-431-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9083
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: