Individual
KEITH FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11349 ST HWY 1056, MCCARR, KY 41544
(606) 427-9007
Mailing address
2274 FEDSCREEK RD, STEELE, KY 41566-8515
(606) 371-4856
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
012854
KY
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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