=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336158385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRUM HEALTH CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 808 SECOND AVE.
-----------------------------------------------------
City | GOLD HILL
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-885-1544
-----------------------------------------------------
Fax | 541-855-1040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 259
-----------------------------------------------------
City | GOLD HILL
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97525-0259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-855-1544
-----------------------------------------------------
Fax | 541-855-1040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. GLENN ALEXANDER FRUM
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 541-855-1544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 00917
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 00917
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------