Organization
FALLS ROAD PHARMACY INC
Active
Other names
FALLS ROAD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GIBBS RPH (OWNER / PIC)
(606) 258-0000
Entity
Organization
Contact information
Practice address
40 MOONBOW PLZ, STE 1, CORBIN, KY 40701-8982
(606) 258-0000
(606) 258-0002
Mailing address
40 MOONBOW PLZ, STE 1, CORBIN, KY 40701-8982
(606) 258-0000
(606) 258-0002
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06831
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1827700
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
54004437
—
KY
Enumeration date
02/12/2007
Last updated
06/07/2012
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