Most Relevant Information
Provider Data
| NPI Number: | 1003199233 |
| Provider Name: | JOHNATHAN T FULLER PHARM.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 015034 |
Most Important Dates
| Enumeration Date: | 09/23/2011 |
| Last Updated: | 09/23/2011 |
Provider Practice Location
2318 FREDERICA ST
OWENSBORO
KY
423014826
Practice Location Phone/Fax
| Phone: | 2706867873 |
| Fax: | 2706867864 |
Provider Mailing Location
2318 FREDERICA ST
OWENSBORO
KY
423014826
Provider Mailing Phone/Fax
| Phone: | 2706867873 |
| Fax: | 2706867864 |