Provider Demographics
NPI:1205140464
Name:FULLOON, LAURA H (RPH)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:H
Last Name:FULLOON
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 1:123 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2644
Mailing Address - Country:US
Mailing Address - Phone:973-627-3312
Mailing Address - Fax:973-586-4320
Practice Address - Street 1:123 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2644
Practice Address - Country:US
Practice Address - Phone:973-627-3312
Practice Address - Fax:973-586-4320
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ00811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist