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General NPI Number Information
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NPI Number | 1295857498
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Entity Type | Organization
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Legal Business Name | AULTMAN PHARMACY INC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 5215 FULTON DR NW # WN
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City | CANTON
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State | OH
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Zip | 44718-1805
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Country | US
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Telephone | 330-433-9005
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Fax | 330-433-9022
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Provider Business Mailing Address
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Address Line | 5215 FULTON DR NW # WN
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City | CANTON
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State | OH
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Zip | 44718-1805
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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 | PHRM MANG
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Name | THOMAS CASEY
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Credential | RPH
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Telephone | 330-433-9005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021673600
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License Number State | OH
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