Provider Demographics
NPI:1164677852
Name:FALLS RIVER PHARMACY LLC
Entity Type:Organization
Organization Name:FALLS RIVER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-835-0457
Mailing Address - Street 1:10930 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6593
Mailing Address - Country:US
Mailing Address - Phone:919-844-2055
Mailing Address - Fax:
Practice Address - Street 1:10930 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6593
Practice Address - Country:US
Practice Address - Phone:919-844-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2800014OtherMEDICARE GROUP/ORGANIZATION PTAN