Provider Demographics
NPI:1457620742
Name:ULLRICH, JOE (RPH)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:ULLRICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:LYNN
Other - Middle Name:JOSEPH
Other - Last Name:ULLRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13501 N CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4816
Mailing Address - Country:US
Mailing Address - Phone:239-997-4332
Mailing Address - Fax:239-997-7389
Practice Address - Street 1:13501 N CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4816
Practice Address - Country:US
Practice Address - Phone:239-997-4332
Practice Address - Fax:239-997-7389
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist