Provider Demographics
NPI:1780204495
Name:FARRELL, JOHN HENRY III (CPHT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:FARRELL
Suffix:III
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1915
Mailing Address - Country:US
Mailing Address - Phone:860-621-9830
Mailing Address - Fax:860-621-9835
Practice Address - Street 1:235 QUEEN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1915
Practice Address - Country:US
Practice Address - Phone:860-621-9830
Practice Address - Fax:860-621-9835
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPTN.0021153183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician