Provider Demographics
NPI:1669787230
Name:FULCHER, BRIAN RICKS (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICKS
Last Name:FULCHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 E FIRE TOWER RD STE E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4127
Mailing Address - Country:US
Mailing Address - Phone:252-355-3538
Mailing Address - Fax:252-758-3324
Practice Address - Street 1:1913 E FIRE TOWER RD STE E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4127
Practice Address - Country:US
Practice Address - Phone:252-355-3538
Practice Address - Fax:252-758-3324
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist