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General NPI Number Information
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NPI Number | 1689958480
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Entity Type | Individual
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Provider Name | EVELYN FULLER RPH
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 4617 JONESBORO RD
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City | UNION CITY
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State | GA
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Zip | 30291-2048
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Country | US
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Telephone | 770-969-7458
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Fax | 770-969-9856
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Provider Business Mailing Address
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Address Line | 7360 HOBGOOD RD
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City | FAIRBURN
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State | GA
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Zip | 30213-2684
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Country | US
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Telephone | 404-200-0531
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Fax | 770-969-9777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 021868
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12094-40
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License Number State | WI
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