MEDICARE: FALKS WOODLAND PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	262025	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2424327	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1104800317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALKS WOODLAND PHARMACY INC

Provider Business Mailing Address
First Line	:	1 E CALVARY RD
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55803-1514
Country	:	US
Telephone Number	:	218-740-4562
Fax Number	:	218-728-9124

Provider Business Practice Location Address
First Line	:	2908 W 3RD ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55806-1702
Country	:	US
Telephone Number	:	218-624-5755
Fax Number	:	218-624-1644

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN PRESTON
Credential	:	RPH
Telephone Number	:	218-525-9850

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/07/2010

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