Provider Demographics
NPI:1649648254
Name:SHULL, FRANKLIN TYLER
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:TYLER
Last Name:SHULL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5919
Mailing Address - Country:US
Mailing Address - Phone:803-612-2841
Mailing Address - Fax:
Practice Address - Street 1:3055 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5919
Practice Address - Country:US
Practice Address - Phone:803-612-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist