Provider Demographics
NPI:1245808567
Name:FALLS RIVER PHARMACY LLC
Entity type:Organization
Organization Name:FALLS RIVER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOLSHOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-844-2055
Mailing Address - Street 1:10930 RAVEN RIDGE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6594
Mailing Address - Country:US
Mailing Address - Phone:919-844-2055
Mailing Address - Fax:
Practice Address - Street 1:10930 RAVEN RIDGE RD STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6594
Practice Address - Country:US
Practice Address - Phone:919-844-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy