Provider Demographics
NPI:1114901550
Name:FALKS WOODLAND PHARMACY INC
Entity Type:Organization
Organization Name:FALKS WOODLAND PHARMACY INC
Other - Org Name:FALKS SPIRIT VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-525-9850
Mailing Address - Street 1:1 E CALVARY RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1514
Mailing Address - Country:US
Mailing Address - Phone:218-740-4562
Mailing Address - Fax:218-728-9124
Practice Address - Street 1:5300 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2903
Practice Address - Country:US
Practice Address - Phone:218-624-1222
Practice Address - Fax:218-624-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MN2624043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2426066OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN006605200Medicaid
MN006605200Medicaid