Provider Demographics
NPI:1619532785
Name:FARLEY, JESSICA RENE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 HIGHWAY 69 N
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-1507
Mailing Address - Country:US
Mailing Address - Phone:205-239-7675
Mailing Address - Fax:205-247-7720
Practice Address - Street 1:1101 SOUTHVIEW LN
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-6389
Practice Address - Country:US
Practice Address - Phone:205-247-7715
Practice Address - Fax:205-247-7720
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist