Provider Demographics
NPI:1538594221
Name:FALCONER PHARMACY, INC
Entity type:Organization
Organization Name:FALCONER PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SARVAIYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-665-1188
Mailing Address - Street 1:202 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-1616
Mailing Address - Country:US
Mailing Address - Phone:716-665-1188
Mailing Address - Fax:716-665-1427
Practice Address - Street 1:202 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-1616
Practice Address - Country:US
Practice Address - Phone:716-665-1188
Practice Address - Fax:716-665-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0322113336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032211OtherPHARMACY LICENCE
NY7060980001Medicare NSC