Provider Demographics
NPI:1902214570
Name:FULMER SUPERMARKETS INC
Entity Type:Organization
Organization Name:FULMER SUPERMARKETS INC
Other - Org Name:COMMUNITY MARKET 710 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-208-6617
Mailing Address - Street 1:317 W MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-3314
Mailing Address - Country:US
Mailing Address - Phone:419-422-8090
Mailing Address - Fax:419-424-3932
Practice Address - Street 1:878 E SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2884
Practice Address - Country:US
Practice Address - Phone:937-593-3600
Practice Address - Fax:937-593-0271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEEDLER ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-28
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0224087503336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108233Medicaid
2147928OtherPK