Provider Demographics
NPI:1750603403
Name:F & G CORNER STORE
Entity type:Organization
Organization Name:F & G CORNER STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:CLEGHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-434-1743
Mailing Address - Street 1:405 W THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1926
Mailing Address - Country:US
Mailing Address - Phone:330-434-1743
Mailing Address - Fax:
Practice Address - Street 1:405 W THORNTON ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1926
Practice Address - Country:US
Practice Address - Phone:330-434-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3013394Medicare PIN