MEDICARE: FRED W ALBRECHT GROCERY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	020155500	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3634929	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1104831031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED W ALBRECHT GROCERY COMPANY

Provider Business Mailing Address
First Line	:	2700 GILCHRIST RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-4433
Country	:	US
Telephone Number	:	330-733-2263
Fax Number	:	330-733-3640

Provider Business Practice Location Address
First Line	:	1474 N MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-1640
Country	:	US
Telephone Number	:	330-497-0645
Fax Number	:	330-497-8402

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY OPERATIONS
Name	:	JEFF MCDOUGAL
Credential	:
Telephone Number	:	330-733-2263

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	09/26/2024

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