Provider Demographics
NPI:1821222399
Name:FULMER, PAUL J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:FULMER
Suffix:
Gender:M
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 1:1317 HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1237
Mailing Address - Country:US
Mailing Address - Phone:308-995-4401
Mailing Address - Fax:308-995-8834
Practice Address - Street 1:1317 HILL ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1237
Practice Address - Country:US
Practice Address - Phone:308-995-4401
Practice Address - Fax:308-995-8834
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063451200Medicaid
NE47077451800Medicaid
NE12653OtherNEBRASKA PHARMACY LICENSE