Healthcare Provider Details

I. General information

NPI: 1063629426
Provider Name (Legal Business Name): JAMES KEVIN FARRELL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6822 EAST 1000 SOUTH
FORT DUCHESNE UT
84026
US

IV. Provider business mailing address

PO BOX 908
VERNAL UT
84078-0908
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6874
  • Fax: 435-725-6889
Mailing address:
  • Phone: 435-789-9490
  • Fax: 435-725-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17931
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: