Provider Demographics
NPI:1720375330
Name:FARRELL, AMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26762 PORTOLA PKWY
Mailing Address - Street 2:T-0913
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1712
Mailing Address - Country:US
Mailing Address - Phone:949-454-2360
Mailing Address - Fax:949-454-2360
Practice Address - Street 1:26762 PORTOLA PKWY
Practice Address - Street 2:T-0913
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1712
Practice Address - Country:US
Practice Address - Phone:949-454-2360
Practice Address - Fax:949-454-2360
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH46759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist