Healthcare Provider Details

I. General information

NPI: 1992820179
Provider Name (Legal Business Name): CZUP FOWLER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 LAKE AVE
ASHTABULA OH
44004-3439
US

IV. Provider business mailing address

2323 LAKE AVE
ASHTABULA OH
44004-3439
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-3000
  • Fax: 440-992-3300
Mailing address:
  • Phone: 440-992-3000
  • Fax: 440-992-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRTP021657500
License Number StateOH

VIII. Authorized Official

Name: MARIA FOWLER
Title or Position: OWNER
Credential: RPH
Phone: 440-992-3000