Provider Demographics
NPI:1912158817
Name:FALCON MEDICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:FALCON MEDICAL SOLUTIONS LLC
Other - Org Name:FALCON MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOMBAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-571-8309
Mailing Address - Street 1:3012 E MAIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0908
Mailing Address - Country:US
Mailing Address - Phone:956-584-9900
Mailing Address - Fax:956-584-9902
Practice Address - Street 1:3012 E MAIN AVE STE A
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-0908
Practice Address - Country:US
Practice Address - Phone:956-584-9900
Practice Address - Fax:956-584-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX26197333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145969Medicaid
4550718OtherNCPDP PROVIDER IDENTIFICATION NUMBER