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General NPI Number Information
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NPI Number | 1942895750
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Entity Type | Individual
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Provider Name | KYRA LASHANE FULCHER PHARM. D
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Gender | Female
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 805 N WHITTINGTON PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-7101
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Country | US
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Telephone | 904-733-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 4507 SONG SPARROW DR
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City | MIDDLEBURG
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State | FL
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Zip | 32068-9050
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Country | US
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Telephone | 904-521-4757
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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 | PS39309
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License Number State | FL
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