MEDICARE: DR. DENNIS KEITH FULLER PHARMD

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	1835P1200X	Pharmacotherapy Pharmacist	10382	NV

General Provider Information

NPI Number	:	1154341394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS KEITH FULLER PHARMD

Provider Business Mailing Address
First Line	:	4833 SPANISH WELLS DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-5545
Country	:	US
Telephone Number	:	702-656-2238
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 S RANCHO DR
Second Line	:	205
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4506
Country	:	US
Telephone Number	:	702-383-2691
Fax Number	:	702-388-4186

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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