Provider Demographics
NPI:1821257759
Name:FULLER-SELLE, LLC
Entity Type:Organization
Organization Name:FULLER-SELLE, LLC
Other - Org Name:PHARMACARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-745-4000
Mailing Address - Street 1:777 E SONTERRA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4250
Mailing Address - Country:US
Mailing Address - Phone:210-745-4000
Mailing Address - Fax:
Practice Address - Street 1:777 E SONTERRA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4250
Practice Address - Country:US
Practice Address - Phone:210-745-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27789333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy