Healthcare Provider Details

I. General information

NPI: 1205929882
Provider Name (Legal Business Name): FITZGERALD SEAMAN PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17860-A ST RT 247
SEAMAN OH
45679
US

IV. Provider business mailing address

PO BOX 247
SEAMAN OH
45679-0247
US

V. Phone/Fax

Practice location:
  • Phone: 937-386-0701
  • Fax: 937-386-1402
Mailing address:
  • Phone: 937-386-0701
  • Fax: 513-734-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021127350
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GERALD M FITZGERALD
Title or Position: GM
Credential:
Phone: 513-734-7335