Provider Demographics
NPI:1295740124
Name:FRED W ALBRECHT GROCERY CO
Entity type:Organization
Organization Name:FRED W ALBRECHT GROCERY CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RX BILLING AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-733-2263
Mailing Address - Street 1:2700 GILCHRIST RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-4433
Mailing Address - Country:US
Mailing Address - Phone:330-733-2263
Mailing Address - Fax:330-733-3640
Practice Address - Street 1:3235 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1400
Practice Address - Country:US
Practice Address - Phone:330-644-0350
Practice Address - Fax:330-644-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OH020081350333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279309Medicaid
3616161OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0279309Medicaid