MEDICARE: DR. RUAL FULLER JR. 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	183500000X	Pharmacist	0202210171	VA

General Provider Information

NPI Number	:	1851833545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUAL FULLER JR. PHARMD

Provider Business Mailing Address
First Line	:	3419 ORANGE AVE NE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24012-6422
Country	:	US
Telephone Number	:	540-283-5128
Fax Number	:	540-283-5122

Provider Business Practice Location Address
First Line	:	3419 ORANGE AVE NE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24012-6422
Country	:	US
Telephone Number	:	540-283-5128
Fax Number	:	540-283-5122

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

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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