Healthcare Provider Details

I. General information

NPI: 1023053261
Provider Name (Legal Business Name): FALLBROOK PHARMACY INC II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E ALVARADO ST STE B
FALLBROOK CA
92028-2966
US

IV. Provider business mailing address

343 E ALVARADO ST STE B
FALLBROOK CA
92028-2966
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-3182
  • Fax: 760-728-2398
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY39905
License Number StateCA

VIII. Authorized Official

Name: RICHARD CLEMENTS
Title or Position: CFO
Credential:
Phone: 760-728-3182