Healthcare Provider Details

I. General information

NPI: 1851856561
Provider Name (Legal Business Name): FULTON PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 25TH ST NW
CANTON OH
44709-3421
US

IV. Provider business mailing address

5713 EAST BLVD NW
CANTON OH
44718-1654
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-2476
  • Fax: 330-456-1973
Mailing address:
  • Phone: 330-832-2226
  • Fax: 330-832-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE A KINGSBURY
Title or Position: PRESIDENT
Credential: RPH
Phone: 330-832-2226