Healthcare Provider Details

I. General information

NPI: 1285003343
Provider Name (Legal Business Name): FRUTH PHARAMCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 21ST ST
NITRO WV
25143-1740
US

IV. Provider business mailing address

106 21ST ST
NITRO WV
25143-1740
US

V. Phone/Fax

Practice location:
  • Phone: 304-755-9015
  • Fax: 304-755-9020
Mailing address:
  • Phone: 304-755-9015
  • Fax: 304-755-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberMP0552419
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022561300
License Number StateOH

VIII. Authorized Official

Name: ANDREW BECKER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 304-675-1612