Provider Demographics
NPI:1225347149
Name:FALLONWELLNESS PHARMACY OF SARATOGA
Entity Type:Organization
Organization Name:FALLONWELLNESS PHARMACY OF SARATOGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-306-5343
Mailing Address - Street 1:472 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2212
Mailing Address - Country:US
Mailing Address - Phone:518-306-5343
Mailing Address - Fax:
Practice Address - Street 1:472 BROADWAY
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2212
Practice Address - Country:US
Practice Address - Phone:518-306-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301663336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy