Provider Demographics
NPI:1992820179
Name:CZUP FOWLER LTD
Entity type:Organization
Organization Name:CZUP FOWLER LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-992-3000
Mailing Address - Street 1:2323 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3439
Mailing Address - Country:US
Mailing Address - Phone:440-992-3000
Mailing Address - Fax:440-992-3300
Practice Address - Street 1:2323 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3439
Practice Address - Country:US
Practice Address - Phone:440-992-3000
Practice Address - Fax:440-992-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRTP0216575003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072161OtherPK
OH4001805Medicaid
6093610001Medicare NSC