Healthcare Provider Details

I. General information

NPI: 1851498679
Provider Name (Legal Business Name): SUSAN SCHNELL FULKERSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD PHARMACY - 119
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

101 RIVER TRACE LN
LITTLE MOUNTAIN SC
29075-9636
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax: 803-695-7921
Mailing address:
  • Phone: 803-730-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9348
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: