Provider Demographics
NPI:1760488340
Name:FALMOUTH PHARMA LLC
Entity Type:Organization
Organization Name:FALMOUTH PHARMA LLC
Other - Org Name:NORTH FALMOUTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SNEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-564-4459
Mailing Address - Street 1:111 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:N FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2019
Mailing Address - Country:US
Mailing Address - Phone:508-564-4459
Mailing Address - Fax:508-564-6172
Practice Address - Street 1:111 COUNTY RD
Practice Address - Street 2:
Practice Address - City:N FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2019
Practice Address - Country:US
Practice Address - Phone:508-564-4459
Practice Address - Fax:508-564-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MADS898953336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143912OtherPK
MA0430129Medicaid