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General NPI Number Information
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NPI Number | 1104931138
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Entity Type | Organization
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Legal Business Name | FAIRMOUNT PHARMACY
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 124 N MAIN ST
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City | FAIRMOUNT
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State | IN
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Zip | 46928-1654
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Country | US
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Telephone | 765-948-4111
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Fax | 765-948-4226
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Provider Business Mailing Address
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Address Line | 610 E ROMIE LN
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City | SALINAS
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State | CA
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Zip | 93901-4209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRADLEY CRUMP
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Credential |
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Telephone | 831-758-0976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 60005862A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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