MEDICARE: WADE FULLMER

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	183500000X	Pharmacist	28731	CA

General Provider Information

NPI Number	:	1295146181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WADE FULLMER

Provider Business Mailing Address
First Line	:	2900 GEER RD STE 200
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-1142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 GEER RD STE 200
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-1142
Country	:	US
Telephone Number	:	209-667-4919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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Directions to “ WADE FULLMER ” Practice Location

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