Provider Demographics
NPI:1114089414
Name:FRUTH PHARMACY INC
Entity Type:Organization
Organization Name:FRUTH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY PROCESSOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-1612
Mailing Address - Street 1:RR 1 BOX 332
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-9726
Mailing Address - Country:US
Mailing Address - Phone:304-675-1612
Mailing Address - Fax:304-675-1657
Practice Address - Street 1:RR 1 BOX 332
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-9726
Practice Address - Country:US
Practice Address - Phone:304-675-1612
Practice Address - Fax:304-675-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWD0558045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty