Provider Demographics
NPI:1043212335
Name:FARRELL, MICHELLE ELLEN (PHARMD, RPH)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELLEN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1532
Mailing Address - Country:US
Mailing Address - Phone:608-375-4466
Mailing Address - Fax:608-375-2383
Practice Address - Street 1:1028 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1532
Practice Address - Country:US
Practice Address - Phone:608-375-4466
Practice Address - Fax:608-375-2383
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X
WI13255-401835P2201X
WI13255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care