Provider Demographics
NPI:1841315470
Name:FULLERTON, WILLIAM R (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:FULLERTON
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 1:6039 ELECTRA LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8150
Mailing Address - Country:US
Mailing Address - Phone:850-497-0587
Mailing Address - Fax:850-497-0588
Practice Address - Street 1:8383 N DAVIS HWY
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6039
Practice Address - Country:US
Practice Address - Phone:850-494-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist