Healthcare Provider Details

I. General information

NPI: 1578095576
Provider Name (Legal Business Name): FULTON PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W PATRICK ST
FREDERICK MD
21701-6946
US

IV. Provider business mailing address

236 N MARKET ST
FREDERICK MD
21701-5335
US

V. Phone/Fax

Practice location:
  • Phone: 240-877-7575
  • Fax: 240-877-7575
Mailing address:
  • Phone: 301-662-4848
  • Fax: 301-620-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPW0514
License Number StateMD

VIII. Authorized Official

Name: MICHAEL WESTBROOK
Title or Position: PRESIDENT
Credential:
Phone: 301-662-4848