Healthcare Provider Details

I. General information

NPI: 1356279095
Provider Name (Legal Business Name): RYLEY MARIE FARWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W STADIUM BLVD
ANN ARBOR MI
48103-4544
US

IV. Provider business mailing address

6451 S LAMBETH CT
CANTON MI
48187-5268
US

V. Phone/Fax

Practice location:
  • Phone: 734-747-7554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: