Provider Demographics
NPI:1700443108
Name:FITZGERALD BETHEL PHARMACY INC
Entity Type:Organization
Organization Name:FITZGERALD BETHEL PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-734-7335
Mailing Address - Street 1:697 W PLANE ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9573
Mailing Address - Country:US
Mailing Address - Phone:513-734-3784
Mailing Address - Fax:513-734-3795
Practice Address - Street 1:697 W PLANE ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9573
Practice Address - Country:US
Practice Address - Phone:513-734-3784
Practice Address - Fax:513-734-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22165350Medicaid