Provider Demographics
NPI:1891374997
Name:FALCON6 PHARMACY NUMBER 1 LLC
Entity Type:Organization
Organization Name:FALCON6 PHARMACY NUMBER 1 LLC
Other - Org Name:BROAD CREEK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FOIL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-971-7535
Mailing Address - Street 1:PO BOX 2490
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-2490
Mailing Address - Country:US
Mailing Address - Phone:919-971-7535
Mailing Address - Fax:
Practice Address - Street 1:2896 HWY 24 UNITS L&M
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570
Practice Address - Country:US
Practice Address - Phone:919-971-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy