Provider Demographics
NPI:1750839668
Name:FAF INC
Entity Type:Organization
Organization Name:FAF INC
Other - Org Name:SPARKMAN PHARMACY-FRANKLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANGER/AO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-705-6499
Mailing Address - Street 1:807 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4311
Mailing Address - Country:US
Mailing Address - Phone:256-429-9821
Mailing Address - Fax:256-429-9823
Practice Address - Street 1:807 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4311
Practice Address - Country:US
Practice Address - Phone:256-429-9821
Practice Address - Fax:256-429-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1146643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL195707Medicaid
2166117OtherPK