=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285523035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEIANA JADA FALTZ PHARMD, RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2025
-----------------------------------------------------
Last Update Date | 06/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CVS DR
-----------------------------------------------------
City | WOONSOCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02895-6146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-746-7287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 RIDGE AVE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18612-3184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-814-3537
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP459374
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------