Provider Demographics
NPI:1063001154
Name:FULLMER, ROBERT KEITH (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KEITH
Last Name:FULLMER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106
Mailing Address - Country:US
Mailing Address - Phone:913-748-0502
Mailing Address - Fax:913-748-0503
Practice Address - Street 1:2300 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106
Practice Address - Country:US
Practice Address - Phone:913-748-0502
Practice Address - Fax:913-748-0503
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist