Provider Demographics
NPI:1720062169
Name:FALKS WOODLAND PHARMACY INC
Entity Type:Organization
Organization Name:FALKS WOODLAND PHARMACY INC
Other - Org Name:FALKS NURSING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-740-4563
Mailing Address - Street 1:231 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3767
Mailing Address - Country:US
Mailing Address - Phone:218-728-4242
Mailing Address - Fax:218-728-9129
Practice Address - Street 1:221 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2704
Practice Address - Country:US
Practice Address - Phone:218-740-2650
Practice Address - Fax:218-740-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI248-43332B00000X
333600000X, 3336C0004X
MN2603633336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN556258900Medicaid
2046461OtherPK
WI33153100Medicaid
WI33153100Medicaid