Provider Demographics
NPI:1841640901
Name:FULMER, CHARLES A (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:FULMER
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 1:2551 LIMESTONE PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2019
Mailing Address - Country:US
Mailing Address - Phone:770-530-5049
Mailing Address - Fax:770-530-2635
Practice Address - Street 1:2551 LIMESTONE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2019
Practice Address - Country:US
Practice Address - Phone:770-530-5049
Practice Address - Fax:770-536-2635
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH008334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist