Healthcare Provider Details

I. General information

NPI: 1821369927
Provider Name (Legal Business Name): MICHAEL EDWARD FRUTH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 JACKSON AVE
POINT PLEASANT WV
25550-2035
US

IV. Provider business mailing address

2501 JACKSON AVE
POINT PLEASANT WV
25550-2035
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-2303
  • Fax:
Mailing address:
  • Phone: 304-675-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03312056
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0003319
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: