Provider Demographics
NPI:1851498679
Name:FULKERSON, SUSAN SCHNELL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SCHNELL
Last Name:FULKERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVER TRACE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE MOUNTAIN
Mailing Address - State:SC
Mailing Address - Zip Code:29075-9636
Mailing Address - Country:US
Mailing Address - Phone:803-730-2554
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:PHARMACY - 119
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-695-7921
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93481835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist