Provider Demographics
NPI:1558583641
Name:FULLER, DEBORAH K (PHARM D)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:FULLER
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 1:1500 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8209
Mailing Address - Country:US
Mailing Address - Phone:954-695-5793
Mailing Address - Fax:
Practice Address - Street 1:1500 LAKEVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8209
Practice Address - Country:US
Practice Address - Phone:954-695-5793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33435183500000X
SCPH10119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist