1225123060 NPI number — FARRELL'S HEALTH CENTERS, INC

Table of content: (NPI 1225123060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225123060 NPI number — FARRELL'S HEALTH CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARRELL'S HEALTH CENTERS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225123060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 S KITSAP BLVD
Provider Second Line Business Mailing Address:
#1800
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-3773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-876-1667
Provider Business Mailing Address Fax Number:
360-895-8255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 S KITSAP BLVD
Provider Second Line Business Practice Location Address:
#1800
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-3773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-876-1667
Provider Business Practice Location Address Fax Number:
360-895-8255
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PHARMACIST/MANAGER
Authorized Official Telephone Number:
360-876-1667

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  CF00001894 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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