Healthcare Provider Details

I. General information

NPI: 1699331868
Provider Name (Legal Business Name): FULTON SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 S ADAMS ST STE D
FULTON MS
38843-6621
US

IV. Provider business mailing address

1509 S ADAMS ST STE D
FULTON MS
38843-6621
US

V. Phone/Fax

Practice location:
  • Phone: 662-245-3080
  • Fax: 888-828-2149
Mailing address:
  • Phone: 662-245-3080
  • Fax: 888-828-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS W FRANCIS
Title or Position: OWNER
Credential:
Phone: 662-245-3080