Provider Demographics
NPI:1003115247
Name:FARRIS, DALE M (DPH)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:M
Last Name:FARRIS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2713
Mailing Address - Country:US
Mailing Address - Phone:615-535-9002
Mailing Address - Fax:
Practice Address - Street 1:5145 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2713
Practice Address - Country:US
Practice Address - Phone:615-535-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist