Provider Demographics
NPI:1841387321
Name:FULTON, MARTINE C (RPH)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:C
Last Name:FULTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6172 WINDLASS CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-5117
Mailing Address - Country:US
Mailing Address - Phone:561-734-8636
Mailing Address - Fax:
Practice Address - Street 1:141 E WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6007
Practice Address - Country:US
Practice Address - Phone:561-736-1010
Practice Address - Fax:561-736-1272
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist