Provider Demographics
NPI:1437364452
Name:FARRELL, MICHAEL EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:FARRELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 GARRARD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-4206
Mailing Address - Country:US
Mailing Address - Phone:859-431-5561
Mailing Address - Fax:
Practice Address - Street 1:301 ELM ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:KY
Practice Address - Zip Code:41016-1450
Practice Address - Country:US
Practice Address - Phone:859-261-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist