Healthcare Provider Details

I. General information

NPI: 1114901550
Provider Name (Legal Business Name): FALKS WOODLAND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BRISTOL ST
DULUTH MN
55807-2903
US

IV. Provider business mailing address

1 E CALVARY RD
DULUTH MN
55803-1514
US

V. Phone/Fax

Practice location:
  • Phone: 218-624-1222
  • Fax: 218-624-1555
Mailing address:
  • Phone: 218-740-4562
  • Fax: 218-728-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262404
License Number StateMN

VIII. Authorized Official

Name: STEVEN PRESTON
Title or Position: OWNER
Credential: RPH
Phone: 218-525-9850