Provider Demographics
NPI:1083864789
Name:FARNELL, KAROL SUE
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:SUE
Last Name:FARNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAROL
Other - Middle Name:SUE
Other - Last Name:FARNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:R PH, II
Mailing Address - Street 1:105 RESERVE
Mailing Address - Street 2:P.O. BOX 1358
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-1358
Mailing Address - Country:US
Mailing Address - Phone:501-701-6217
Mailing Address - Fax:501-624-0019
Practice Address - Street 1:105 RESERVE ST
Practice Address - Street 2:105 RESERVE
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-4195
Practice Address - Country:US
Practice Address - Phone:501-624-4411
Practice Address - Fax:501-624-0019
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD07687OtherLICENSE #PD07687