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General NPI Number Information
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NPI Number | 1841161106
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Entity Type | Individual
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Provider Name | LYNN Z FULLER RPH
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Gender | Female
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2100 GARDINER LN
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City | LOUISVILLE
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State | KY
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Zip | 40205-2962
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Country | US
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Telephone | 502-413-8952
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Fax |
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Provider Business Mailing Address
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Address Line | 100 RIDGE RD
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City | VERSAILLES
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State | KY
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Zip | 40383-1333
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Country | US
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Telephone | 502-413-8952
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Fax |
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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 | 010150
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License Number State | KY
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