Provider Demographics
NPI:1053456483
Name:FARKAS, ALAN P (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:P
Last Name:FARKAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 N 140 W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9748
Mailing Address - Country:US
Mailing Address - Phone:765-463-2858
Mailing Address - Fax:
Practice Address - Street 1:575 STADIUM MALL DR
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47907-2091
Practice Address - Country:US
Practice Address - Phone:765-494-1374
Practice Address - Fax:765-496-6094
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist