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NPI Code Detail

MEDICARE: MR. ROBERT IRWIN FULFORD R.PH.

MEDICARE: MR. ROBERT IRWIN FULFORD R.PH.
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
1183500000XPharmacist11833TN

General Provider Information

NPI Number : 1790829067
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT IRWIN FULFORD R.PH.
Provider Business Mailing Address
First Line : 440 HICKS BRANCH RD
Second Line :
City : RELIANCE
State : TN
Zip : 37369-4421
Country : US
Telephone Number : 423-338-4349
Fax Number : 423-338-2253
Provider Business Practice Location Address
First Line : 2300 TREASURY DR SE
Second Line :
City : CLEVELAND
State : TN
Zip : 37323-7185
Country : US
Telephone Number : 423-472-0656
Fax Number : 423-472-0557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 07/08/2007

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