Healthcare Provider Details

I. General information

NPI: 1053602961
Provider Name (Legal Business Name): MARTIN G ALBAUGH JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WATER ST
CHARDON OH
44024-1146
US

IV. Provider business mailing address

501 WATER ST
CHARDON OH
44024-1146
US

V. Phone/Fax

Practice location:
  • Phone: 440-286-4167
  • Fax: 440-285-3141
Mailing address:
  • Phone: 440-286-4167
  • Fax: 440-285-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03 10 7996
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: