Provider Demographics
NPI:1144801986
Name:FULTON, BRET R (RPH)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:R
Last Name:FULTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 RED ASH LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9545
Mailing Address - Country:US
Mailing Address - Phone:720-933-5663
Mailing Address - Fax:
Practice Address - Street 1:3140 VILLAGE VISTA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2527
Practice Address - Country:US
Practice Address - Phone:720-890-5095
Practice Address - Fax:720-890-4343
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist