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General NPI Number Information
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NPI Number | 1891905030
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Entity Type | Individual
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Provider Name | JOHN DAVID FULTON
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2451 FILLINGIM ST PHARMACY DEPARTMENT
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City | MOBILE
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State | AL
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Zip | 36617-2238
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Country | US
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Telephone | 251-471-7388
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Fax |
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Provider Business Mailing Address
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Address Line | 8226 PINE LOG CT
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City | DAPHNE
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State | AL
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Zip | 36526-6152
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Country | US
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Telephone | 251-626-5902
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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 | 11273
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License Number State | AL
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