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NPI Code Detail

MEDICARE: JESSICA RENE FARLEY

MEDICARE: JESSICA RENE FARLEY
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
1183500000XPharmacist17108AL

General Provider Information

NPI Number : 1619532785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RENE FARLEY
Provider Business Mailing Address
First Line : 6085 HIGHWAY 69 N
Second Line :
City : NORTHPORT
State : AL
Zip : 35473-1507
Country : US
Telephone Number : 205-239-7675
Fax Number : 205-247-7720
Provider Business Practice Location Address
First Line : 1101 SOUTHVIEW LN
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35405-6389
Country : US
Telephone Number : 205-247-7715
Fax Number : 205-247-7720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2019
Last Update Date : 05/04/2019

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Directions to “ JESSICA RENE FARLEY ” Practice Location

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