Healthcare Provider Details

I. General information

NPI: 1104751122
Provider Name (Legal Business Name): KEIRA FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 RIVERSIDE DR
JOHNSON CITY NY
13790-2734
US

IV. Provider business mailing address

807 WOODLAND DR
KINGSTON PA
18704-3917
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-1588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: