Provider Demographics
NPI:1437420817
Name:FAF INC
Entity Type:Organization
Organization Name:FAF INC
Other - Org Name:HEALTHMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-705-6499
Mailing Address - Street 1:2015 SPARKMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3815
Mailing Address - Country:US
Mailing Address - Phone:256-715-7475
Mailing Address - Fax:256-715-7418
Practice Address - Street 1:2015 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3815
Practice Address - Country:US
Practice Address - Phone:256-715-7475
Practice Address - Fax:256-715-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1138493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133532OtherPK
AL135348Medicaid
Q003930001OtherPTAN