Provider Demographics
NPI:1407179088
Name:FARRELL, JACQUELINE (RPH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2644
Mailing Address - Country:US
Mailing Address - Phone:585-544-8550
Mailing Address - Fax:585-342-8487
Practice Address - Street 1:2200 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2644
Practice Address - Country:US
Practice Address - Phone:585-544-8550
Practice Address - Fax:585-342-8487
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052564OtherPHARMACIST LICENSE #