Provider Demographics
NPI:1336733914
Name:FARAH, GEORGE JACK JR
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JACK
Last Name:FARAH
Suffix:JR
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 1:150 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-3704
Mailing Address - Country:US
Mailing Address - Phone:904-355-5646
Mailing Address - Fax:904-355-6263
Practice Address - Street 1:150 E 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3704
Practice Address - Country:US
Practice Address - Phone:904-355-5646
Practice Address - Fax:904-355-6263
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist