Provider Demographics
NPI:1417397936
Name:FULLERTON, CAREEN ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:CAREEN
Middle Name:ELIZABETH
Last Name:FULLERTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CAREEN
Other - Middle Name:ELIZABETH
Other - Last Name:LEMEILLEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 GREEN MDWS
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5538
Mailing Address - Country:US
Mailing Address - Phone:830-456-6180
Mailing Address - Fax:
Practice Address - Street 1:6844 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969-4548
Practice Address - Country:US
Practice Address - Phone:936-853-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist