MEDICARE: BETTY FARMER RPH

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	119939	MN

General Provider Information

NPI Number	:	1205383791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY FARMER RPH

Provider Business Mailing Address
First Line	:	24760 HOSPITAL DR.
Second Line	:	PO BOX 497
City	:	REDLAKE
State	:	MN
Zip	:	56671-0497
Country	:	US
Telephone Number	:	218-679-0173
Fax Number	:	218-679-0189

Provider Business Practice Location Address
First Line	:	24760 HOSPITAL DR.
Second Line	:
City	:	REDLAKE
State	:	MN
Zip	:	56671-0497
Country	:	US
Telephone Number	:	218-679-0173
Fax Number	:	218-679-0189

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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Directions to “ BETTY FARMER RPH” Practice Location

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