Healthcare Provider Details

I. General information

NPI: 1609184902
Provider Name (Legal Business Name): ANTHONY FRANCIS FULLER PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 5TH ST
STRUTHERS OH
44471-1527
US

IV. Provider business mailing address

982 5TH ST
STRUTHERS OH
44471-1527
US

V. Phone/Fax

Practice location:
  • Phone: 330-750-0006
  • Fax: 330-750-0296
Mailing address:
  • Phone: 330-750-0006
  • Fax: 330-750-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03129822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: