1477568301 NPI number — FRED W ALBRECHT GROCERY CO

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 1477568301 NPI number — FRED W ALBRECHT GROCERY CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRED W ALBRECHT GROCERY CO
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:
Provider Other Organization Name Type Code:
6
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:
1477568301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 GILCHRIST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44305-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-733-2263
Provider Business Mailing Address Fax Number:
330-733-3640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2630 BAILEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUYAHOGA FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44221-2216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-923-5766
Provider Business Practice Location Address Fax Number:
330-923-5612
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDOUGAL
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY OPERATIONS
Authorized Official Telephone Number:
330-733-2263

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  021154750 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3667271 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2139582 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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