Provider Demographics
NPI:1073116950
Name:FARRELL PHARMACY GROUP, INC.
Entity Type:Organization
Organization Name:FARRELL PHARMACY GROUP, INC.
Other - Org Name:CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:608-391-0420
Mailing Address - Street 1:190 N ORANGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2163
Mailing Address - Country:US
Mailing Address - Phone:608-647-8918
Mailing Address - Fax:608-647-3696
Practice Address - Street 1:190 N ORANGE ST STE 2
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2163
Practice Address - Country:US
Practice Address - Phone:608-647-8918
Practice Address - Fax:608-647-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-21
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100148468Medicaid