Healthcare Provider Details

I. General information

NPI: 1265627681
Provider Name (Legal Business Name): FALKS WOODLAND PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WOODLAND AVE
DULUTH MN
55803-2628
US

IV. Provider business mailing address

1 E CALVARY RD
DULUTH MN
55803-1514
US

V. Phone/Fax

Practice location:
  • Phone: 218-740-5600
  • Fax: 218-740-5601
Mailing address:
  • Phone: 218-740-4562
  • Fax: 218-728-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263069
License Number StateMN

VIII. Authorized Official

Name: MICHAEL GROTH
Title or Position: DIR OPS
Credential:
Phone: 218-740-4563