Provider Demographics
NPI:1598845547
Name:FAULKENBERG HARTH INC
Entity Type:Organization
Organization Name:FAULKENBERG HARTH INC
Other - Org Name:ROCKPORT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-649-9181
Mailing Address - Street 1:400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1420
Mailing Address - Country:US
Mailing Address - Phone:812-649-9181
Mailing Address - Fax:812-649-4758
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1420
Practice Address - Country:US
Practice Address - Phone:812-649-9181
Practice Address - Fax:812-649-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
IN60006020A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1598845547OtherNPI
1561213OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1561213OtherNCPDP PROVIDER IDENTIFICATION NUMBER