1336292283 NPI number — FARRELL'S HEALTH CTRS., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336292283 NPI number — FARRELL'S HEALTH CTRS., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARRELL'S HEALTH CTRS., 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:
FARRELL'S EASTWOOD PHARMACY
Provider Other Organization Name Type Code:
3
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:
1336292283
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:
2518 WHEATON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-377-3753
Provider Business Mailing Address Fax Number:
360-377-0125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2518 WHEATON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-377-3753
Provider Business Practice Location Address Fax Number:
360-377-0125
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRAMER
Authorized Official First Name:
CARL
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
360-377-0164

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  026202CF00001658 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X , with the licence number: 026202CF00001658 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336M0002X , with the licence number: 026202CF00001658 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 6129704 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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