Provider Demographics
NPI:1598073058
Name:FULLER, JAMES H (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:FULLER
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 1:2615 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5127
Mailing Address - Country:US
Mailing Address - Phone:318-396-6421
Mailing Address - Fax:318-396-6480
Practice Address - Street 1:2615 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5127
Practice Address - Country:US
Practice Address - Phone:318-396-6421
Practice Address - Fax:318-396-6480
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist