Provider Demographics
NPI:1184007882
Name:FULKROD, DANIELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FULKROD
Suffix:
Gender:F
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 1:103 N SHADY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-1333
Mailing Address - Country:US
Mailing Address - Phone:423-727-5651
Mailing Address - Fax:
Practice Address - Street 1:103 N SHADY ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-1333
Practice Address - Country:US
Practice Address - Phone:423-727-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214028183500000X
TN39961183500000X
WVRP0009444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist