Healthcare Provider Details

I. General information

NPI: 1053115386
Provider Name (Legal Business Name): FULTONPURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1172 FULTON ST
BROOKLYN NY
11216-2695
US

IV. Provider business mailing address

1172 FULTON ST
BROOKLYN NY
11216-2695
US

V. Phone/Fax

Practice location:
  • Phone: 718-795-0055
  • Fax: 718-795-0056
Mailing address:
  • Phone: 718-795-0055
  • Fax: 718-795-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD ELGENDY
Title or Position: PRESIDENT
Credential:
Phone: 718-795-0055