Individual
STEVEN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1735 VIRGINIA AVE, NORTH BEND, OR 97459-2346
(503) 751-7006
Mailing address
PO BOX 632, NORTH BEND, OR 97459-0051
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11739
OR
Other
Enumeration date
10/30/2010
Last updated
10/30/2010
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