Provider Demographics
NPI:1336292283
Name:FARRELL'S HEALTH CTRS., INC.
Entity Type:Organization
Organization Name:FARRELL'S HEALTH CTRS., INC.
Other - Org Name:FARRELL'S EASTWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-377-0164
Mailing Address - Street 1:2518 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3303
Mailing Address - Country:US
Mailing Address - Phone:360-377-3753
Mailing Address - Fax:360-377-0125
Practice Address - Street 1:2518 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-377-3753
Practice Address - Fax:360-377-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA026202CF00001658333600000X, 3336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6129704Medicaid
WA6129704Medicaid