Provider Demographics
NPI:1467177485
Name:AULTMAN HOSPITAL
Entity Type:Organization
Organization Name:AULTMAN HOSPITAL
Other - Org Name:AULTMAN SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-363-3889
Mailing Address - Street 1:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-0690
Mailing Address - Country:US
Mailing Address - Phone:330-588-4758
Mailing Address - Fax:
Practice Address - Street 1:2500 WALES AVE NW STE B
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2324
Practice Address - Country:US
Practice Address - Phone:330-588-4758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy