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General NPI Number Information
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NPI Number | 1841315470
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Entity Type | Individual
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Provider Name | WILLIAM R. FULLERTON RPH
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8383 N DAVIS HWY PHARMACY DEPT.
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City | PENSACOLA
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State | FL
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Zip | 32514-6039
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Country | US
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Telephone | 850-494-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 6039 ELECTRA LN
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City | PENSACOLA
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State | FL
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Zip | 32507-8150
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Country | US
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Telephone | 850-497-0587
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Fax | 850-497-0588
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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 | PS31160
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License Number State | FL
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