Provider Demographics
NPI:1558679027
Name:FARRAR, ELTON RANDOLPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:ELTON
Middle Name:RANDOLPH
Last Name:FARRAR
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 1:216 FRENCHMANS BEND PL
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8931
Mailing Address - Country:US
Mailing Address - Phone:318-322-4350
Mailing Address - Fax:
Practice Address - Street 1:2913 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7207
Practice Address - Country:US
Practice Address - Phone:318-654-8756
Practice Address - Fax:318-654-8759
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.011406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist