MEDICARE: MR. DONALD JOSEPH PULLEY JR. RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11147	SC
2	183500000X	Pharmacist	RP036113L	PA

General Provider Information

NPI Number	:	1023366184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD JOSEPH PULLEY JR. RPH

Provider Business Mailing Address
First Line	:	302 WINDING RIVER LN
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-6526
Country	:	US
Telephone Number	:	864-329-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 HIGHWAY 153
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7553
Country	:	US
Telephone Number	:	864-220-1380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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