Provider Demographics
NPI:1902189533
Name:FARLEY, AMY M (RPH)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:FARLEY
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 1:123 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-1409
Mailing Address - Country:US
Mailing Address - Phone:260-724-2585
Mailing Address - Fax:
Practice Address - Street 1:123 N 13TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-1409
Practice Address - Country:US
Practice Address - Phone:260-724-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021454A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist