Healthcare Provider Details

I. General information

NPI: 1780967950
Provider Name (Legal Business Name): DAVID MICHAEL FUHL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W RAAB RD
NORMAL IL
61761-1007
US

IV. Provider business mailing address

706 N PROSPECT MANOR AVE
MT PROSPECT IL
60056-2052
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-7347
  • Fax:
Mailing address:
  • Phone: 847-504-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294833
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: