Provider Demographics
NPI:1215909965
Name:FARRIS, GREG W (DPH)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:W
Last Name:FARRIS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 STILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-6152
Mailing Address - Country:US
Mailing Address - Phone:615-591-6388
Mailing Address - Fax:615-591-6387
Practice Address - Street 1:391 WALLACE RD
Practice Address - Street 2:DEPARTMENT OF PHARMACY SERVICES
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4851
Practice Address - Country:US
Practice Address - Phone:615-781-4620
Practice Address - Fax:615-781-3611
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist