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Contact Information

FULTON ROAD PHARMACY INC
1657 25TH ST NW
CANTON, OH44709-3421
 Phone: 330-456-2476
 Fax: 330-456-1973
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for FULTON ROAD PHARMACY INC

NPI Number 1134203268
LBN Legal business name FULTON ROAD PHARMACY INC
Authorized official TIMOTHY KINGSBURY - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/25/2006
Last updated 12/01/2016 - About 10 years ago
Identifiers
OH License # 021296900
OH Medicaid 2286477
Other 2078516 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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