Provider Demographics
NPI:1922013853
Name:FRED W ALBRECHT GROCERY CO
Entity Type:Organization
Organization Name:FRED W ALBRECHT GROCERY CO
Other - Org Name:ACME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-733-2263
Mailing Address - Street 1:ACME PHARMACY
Mailing Address - Street 2:PO BOX 567
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-0567
Mailing Address - Country:US
Mailing Address - Phone:330-733-2263
Mailing Address - Fax:330-733-3640
Practice Address - Street 1:2905 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1533
Practice Address - Country:US
Practice Address - Phone:330-478-1821
Practice Address - Fax:330-478-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020185900333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0488637Medicaid
3639272OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0349890007Medicare NSC