Healthcare Provider Details

I. General information

NPI: 1538594221
Provider Name (Legal Business Name): FALCONER PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 05/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W MAIN ST
FALCONER NY
14733-1616
US

IV. Provider business mailing address

202 W MAIN ST
FALCONER NY
14733-1616
US

V. Phone/Fax

Practice location:
  • Phone: 716-665-1188
  • Fax: 716-665-1427
Mailing address:
  • Phone: 716-665-1188
  • Fax: 716-665-1427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number032211
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032211
License Number StateNY

VIII. Authorized Official

Name: MR. SALIM SARVAIYA
Title or Position: RPH/VICE PRESIDENT
Credential: RPH
Phone: 716-665-1188