Provider Demographics
NPI:1699028175
Name:FULLER, RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:FULLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7750
Mailing Address - Country:US
Mailing Address - Phone:716-631-3381
Mailing Address - Fax:
Practice Address - Street 1:1142 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7750
Practice Address - Country:US
Practice Address - Phone:716-631-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-20
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060165183500000X, 183500000X
NY092525390200000X
VA0203016100390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program