Provider Demographics
NPI:1295086957
Name:FARNES, EDWARD DEAN
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DEAN
Last Name:FARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10096 KENAI SPUR HWY
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7807
Mailing Address - Country:US
Mailing Address - Phone:907-395-0871
Mailing Address - Fax:907-395-4038
Practice Address - Street 1:10096 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7807
Practice Address - Country:US
Practice Address - Phone:907-395-0871
Practice Address - Fax:907-395-4038
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1843183500000X
MT2459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist