Healthcare Provider Details

I. General information

NPI: 1205383791
Provider Name (Legal Business Name): BETTY FARMER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24760 HOSPITAL DR.
REDLAKE MN
56671-0497
US

IV. Provider business mailing address

24760 HOSPITAL DR. PO BOX 497
REDLAKE MN
56671-0497
US

V. Phone/Fax

Practice location:
  • Phone: 218-679-0173
  • Fax: 218-679-0189
Mailing address:
  • Phone: 218-679-0173
  • Fax: 218-679-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119939
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: