Provider Demographics
NPI:1336158385
Name:FRUM HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:FRUM HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FRUM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-855-1544
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:GOLD HILL
Mailing Address - State:OR
Mailing Address - Zip Code:97525-0259
Mailing Address - Country:US
Mailing Address - Phone:541-855-1544
Mailing Address - Fax:541-855-1040
Practice Address - Street 1:808 SECOND AVE.
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:OR
Practice Address - Zip Code:97525
Practice Address - Country:US
Practice Address - Phone:541-885-1544
Practice Address - Fax:541-855-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00917333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134333Medicaid
OR3810707OtherNCPDP NUMBER
1336158385OtherNPI
ORBG4798180OtherDEA NUMBER