Provider Demographics
NPI:1023408853
Name:FARMER, PAMELA SUE
Entity type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:SUE
Last Name:FARMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 HUSTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:CARET
Mailing Address - State:VA
Mailing Address - Zip Code:22436
Mailing Address - Country:US
Mailing Address - Phone:804-445-6399
Mailing Address - Fax:
Practice Address - Street 1:4824 HUSTLE RD
Practice Address - Street 2:
Practice Address - City:CARET
Practice Address - State:VA
Practice Address - Zip Code:22436-2209
Practice Address - Country:US
Practice Address - Phone:804-445-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230021419183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician