MEDICARE: JESSICA NICOLE FARMER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202208063	VA

General Provider Information

NPI Number	:	1194027979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NICOLE FARMER PHARMD

Provider Business Mailing Address
First Line	:	3431 KILBURN CIR
Second Line	:	APT 523
City	:	RICHMOND
State	:	VA
Zip	:	23233-1098
Country	:	US
Telephone Number	:	804-338-2718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 HICKS RD
Second Line	:	KROGER PHARMACY
City	:	RICHMOND
State	:	VA
Zip	:	23235-6337
Country	:	US
Telephone Number	:	804-675-4519
Fax Number	:	804-675-4528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	11/29/2010

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