Provider Demographics
NPI:1437765856
Name:FULKS, GILBERT MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:MICHAEL
Last Name:FULKS
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:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-0985
Mailing Address - Country:US
Mailing Address - Phone:740-867-6133
Mailing Address - Fax:
Practice Address - Street 1:2901 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1407
Practice Address - Country:US
Practice Address - Phone:304-697-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003946183500000X
OH03314210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist