1073528907 NPI number — FRUTH PHARMACY OF OHIO INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073528907 NPI number — FRUTH PHARMACY OF OHIO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRUTH PHARMACY OF OHIO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRUTH PHARMACY 15
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073528907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FRUTH CORPORATE OFFICES
Provider Second Line Business Mailing Address:
4016 OHIO RIVER ROAD
Provider Business Mailing Address City Name:
POINT PLEASANT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-675-1612
Provider Business Mailing Address Fax Number:
304-675-7338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELPRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45714-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-423-9561
Provider Business Practice Location Address Fax Number:
740-423-0139
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
304-675-1612

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 020690550 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0854740 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073528907 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0227766007 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2072393 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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