Provider Demographics
NPI:1174864011
Name:FRUTH PHARMACY OF OHIO INC
Entity Type:Organization
Organization Name:FRUTH PHARMACY OF OHIO INC
Other - Org Name:FRUTH PHARMACY 27
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE ADM
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:FRUTH CORPORATE OFFICES
Mailing Address - Street 2:4016 OHIO RIVER ROAD
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550
Mailing Address - Country:US
Mailing Address - Phone:304-675-1612
Mailing Address - Fax:304-675-7905
Practice Address - Street 1:1848 STATE ROUTE 141
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-5213
Practice Address - Country:US
Practice Address - Phone:740-532-7943
Practice Address - Fax:740-532-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-22897503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139332OtherPK
OH0080913Medicaid
2139332OtherPK