Provider Demographics
NPI:1275138232
Name:FULTON, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FULTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15843 E HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488-4149
Mailing Address - Country:US
Mailing Address - Phone:352-625-6300
Mailing Address - Fax:
Practice Address - Street 1:15843 E HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488-4149
Practice Address - Country:US
Practice Address - Phone:352-625-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist