Organization
FULTON PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE NASH ANTHONY RPH (VICE PRESIDENT)
(616) 791-2014
Entity
Organization
Contact information
Practice address
738 W FULTON ST, GRAND RAPIDS, MI 49504-6320
(616) 293-1258
Mailing address
4291 MOHAVE CT SW, GRANDVILLE, MI 49418-1739
(616) 293-1258
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301005576
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2348678
NABP
—
05
—
2348678
—
MI
05
—
4734275
—
MI
Enumeration date
10/19/2005
Last updated
03/07/2023
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