Active NPI
Charles O Faulconer Jr., RPH
- Pharmacist
- Forest, VA
National Provider Identifier
1194006429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202005091
- Practice address
- 17421 Forest Rd
Forest, VA 24551-5020 - Phone
- (434) 316-5403
- Fax
- (434) 316-5407
- NPI assigned
- Aug 31, 2011
- Last updated
- Aug 31, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202005091 | VA | Primary |
Addresses
Primary practice location
17421 Forest Rd
Forest, VA 24551-5020
Mailing address
17421 Forest Rd
Forest, VA 24551-5020
Phone (434) 316-5403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202005091 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co. | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314748800000",
"number": "1194006429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17421 FOREST RD",
"city": "FOREST",
"state": "VA",
"postal_code": "245515020",
"telephone_number": "434-316-5403",
"fax_number": "434-316-5407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17421 FOREST RD",
"city": "FOREST",
"state": "VA",
"postal_code": "245515020",
"telephone_number": "434-316-5403",
"fax_number": "434-316-5407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULCONER",
"first_name": "CHARLES",
"middle_name": "O",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-31",
"last_updated": "2011-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202005091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.