Provider Demographics
NPI:1710298955
Name:FARRIS, PATRICIA SUE (DPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:FARRIS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1836
Mailing Address - Country:US
Mailing Address - Phone:423-764-3261
Mailing Address - Fax:423-764-3006
Practice Address - Street 1:2412 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1836
Practice Address - Country:US
Practice Address - Phone:423-764-3261
Practice Address - Fax:423-764-3006
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN928183500000X
VA0202005870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist