Provider Demographics
NPI:1013343698
Name:FULMER, MARQUES EUGENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARQUES
Middle Name:EUGENE
Last Name:FULMER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5823
Mailing Address - Country:US
Mailing Address - Phone:954-449-7940
Mailing Address - Fax:
Practice Address - Street 1:181 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2015
Practice Address - Country:US
Practice Address - Phone:954-472-3861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist