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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0004X	Compounding Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	205140	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2404553	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992787014
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	:	218-728-4242
Fax Number	:	218-728-4247

Provider Business Practice Location Address
First Line	:	1 E CALVARY RD
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55803-1514
Country	:	US
Telephone Number	:	218-728-4242
Fax Number	:	218-728-4247

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/07/2010

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