Healthcare Provider Details

I. General information

NPI: 1831104769
Provider Name (Legal Business Name): FRED W ALBRECHT GROCERY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 STATE ROUTE 59
KENT OH
44240-2849
US

IV. Provider business mailing address

ACME PHARMACY PO BOX 567
AKRON OH
44309-0567
US

V. Phone/Fax

Practice location:
  • Phone: 330-678-3662
  • Fax: 330-678-2265
Mailing address:
  • Phone: 330-733-2263
  • Fax: 330-733-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number020398500
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY MCDOUGAL
Title or Position: RX BILLING AND COMPLIANCE
Credential:
Phone: 307-332-2633