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General NPI Number Information
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NPI Number | 1821257759
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Entity Type | Organization
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Legal Business Name | FULLER-SELLE, LLC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 777 E SONTERRA BLVD STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4250
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Country | US
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Telephone | 210-745-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 777 E SONTERRA BLVD STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4250
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Country | US
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Telephone | 210-745-4000
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN K FULLER
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Credential | RPH
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Telephone | 210-745-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 27789
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License Number State | TX
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