Provider Demographics
NPI:1265432561
Name:FALLS CITY MEDS INC
Entity type:Organization
Organization Name:FALLS CITY MEDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGESANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-687-3393
Mailing Address - Street 1:120 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2116
Mailing Address - Country:US
Mailing Address - Phone:402-245-2029
Mailing Address - Fax:402-245-2521
Practice Address - Street 1:120 E 18TH ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2116
Practice Address - Country:US
Practice Address - Phone:402-245-2029
Practice Address - Fax:402-245-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NE29393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136754OtherPK
NE100262262-00Medicaid
KS200257510AMedicaid
KS200257510AMedicaid