Provider Demographics
NPI:1598914079
Name:FULLEM, ALICIA MAY (RPH, PHARMD)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MAY
Last Name:FULLEM
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LINCOLN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2412
Mailing Address - Country:US
Mailing Address - Phone:302-559-7545
Mailing Address - Fax:
Practice Address - Street 1:150 LINCOLN ST APT 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2412
Practice Address - Country:US
Practice Address - Phone:302-559-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist