Provider Demographics
NPI:1326635301
Name:FULTINEER, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FULTINEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 FIELDGATE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2150
Mailing Address - Country:US
Mailing Address - Phone:412-519-8832
Mailing Address - Fax:
Practice Address - Street 1:70 W STEUBEN ST
Practice Address - Street 2:
Practice Address - City:CRAFTON
Practice Address - State:PA
Practice Address - Zip Code:15205-2644
Practice Address - Country:US
Practice Address - Phone:412-921-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040580L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty