Provider Demographics
NPI:1790963635
Name:FARRELL, JOANN (RPH)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6636
Mailing Address - Country:US
Mailing Address - Phone:716-488-0778
Mailing Address - Fax:716-484-3342
Practice Address - Street 1:19 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6636
Practice Address - Country:US
Practice Address - Phone:716-488-0778
Practice Address - Fax:716-484-3342
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029362OtherNY STATE PHARMACY LICENSE