Provider Demographics
NPI:1225123060
Name:FARRELL'S HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:FARRELL'S HEALTH CENTERS, INC
Other - Org Name:FARRELL'S PORT ORCHARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-876-1667
Mailing Address - Street 1:450 S KITSAP BLVD
Mailing Address - Street 2:#1800
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3773
Mailing Address - Country:US
Mailing Address - Phone:360-876-1667
Mailing Address - Fax:360-895-8255
Practice Address - Street 1:450 S KITSAP BLVD
Practice Address - Street 2:#1800
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3773
Practice Address - Country:US
Practice Address - Phone:360-876-1667
Practice Address - Fax:360-895-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00001894333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy