MEDICARE: FALLS DRUG STORE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301004473	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033310743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLS DRUG STORE INC

Provider Business Mailing Address
First Line	:	324 SUPERIOR AVE
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-1427
Country	:	US
Telephone Number	:	906-875-6781
Fax Number	:	906-875-6781

Provider Business Practice Location Address
First Line	:	324 SUPERIOR AVE
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-1427
Country	:	US
Telephone Number	:	906-875-6781
Fax Number	:	906-875-6781

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES JOSEPH KUNZ
Credential	:	RPH
Telephone Number	:	906-875-6781

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/22/2020

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Directions to “FALLS DRUG STORE INC ” Practice Location

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