Provider Demographics
NPI:1548552672
Name:FAULK, MARK S (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:FAULK
Suffix:
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 1:191 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-2449
Mailing Address - Country:US
Mailing Address - Phone:913-487-5181
Mailing Address - Fax:912-487-0087
Practice Address - Street 1:191 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2449
Practice Address - Country:US
Practice Address - Phone:912-487-5181
Practice Address - Fax:912-487-0087
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAROH017106183500000X
GA017106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist