Healthcare Provider Details

I. General information

NPI: 1609955186
Provider Name (Legal Business Name): FALLON FAMILY DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 11TH STREET, NUMBER 2
LOVELOCK NV
89419
US

IV. Provider business mailing address

5424 OAKWOOD CIR FALLON
FALLON NV
89406-4272
US

V. Phone/Fax

Practice location:
  • Phone: 775-273-1700
  • Fax: 775-273-9013
Mailing address:
  • Phone: 775-426-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNV

VIII. Authorized Official

Name: MR. GRANT S. MOULTON
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 775-426-9385