Provider Demographics
NPI:1629689575
Name:FARRIS, JOHN STEPHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHAN
Last Name:FARRIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 PLEASANT ST APT 376
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5492
Mailing Address - Country:US
Mailing Address - Phone:815-761-1833
Mailing Address - Fax:
Practice Address - Street 1:8701 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2200
Practice Address - Country:US
Practice Address - Phone:515-270-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist