NPIMap

Organization Active NPI

Fallon Wellness Pharmacy

  • Compounding Pharmacy
  • Latham, NY
National Provider Identifier
1215077532
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
026112 Issued in NY
Legal business name
FALLON WELLNESS PHARMACY
Practice address
1057 Troy Schenectady Rd
Latham, NY 12110-1002
Phone
(518) 220-2005
Fax
(518) 220-5004
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Peter Lawrence FallonNPI 1780129619
Title
Pharmacist
Phone
(518) 220-2005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X 026112 NY Primary

Addresses

Primary practice location

1057 Troy Schenectady Rd
Latham, NY 12110-1002

Mailing address

1057 Troy Schenectady Rd
Latham, NY 12110-1002
Phone (518) 220-2005

Other identifiers 1

IdentifierTypeStateIssuer
02443983MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Fallon Wellness Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1057 Troy Schenectady Rd
Latham, NY 12110
Phone (518) 220-2005

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215077532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 TROY SCHENECTADY RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121101002",
            "telephone_number": "518-220-2005",
            "fax_number": "518-220-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 TROY SCHENECTADY RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121101002",
            "telephone_number": "518-220-2005",
            "fax_number": "518-220-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLON WELLNESS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FALLON",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "518-220-2005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NY",
            "license": "026112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02443983",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Latham, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.