Provider Demographics
NPI:1811235286
Name:FULLER, CHRISTOPHER PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:FULLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3720 NW 13TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-5906
Mailing Address - Country:US
Mailing Address - Phone:352-335-2363
Mailing Address - Fax:352-335-2095
Practice Address - Street 1:3720 NW 13TH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-5906
Practice Address - Country:US
Practice Address - Phone:352-335-2363
Practice Address - Fax:352-335-2095
Is Sole Proprietor?:No
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist