Provider Demographics
NPI:1215269113
Name:FALLI, PETER E JR (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:FALLI
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2404
Mailing Address - Country:US
Mailing Address - Phone:845-856-4120
Mailing Address - Fax:845-856-7496
Practice Address - Street 1:34-38 BALL ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2460
Practice Address - Country:US
Practice Address - Phone:845-856-4120
Practice Address - Fax:845-856-7496
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026999-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist