Individual
SALLY SUZANNE FULLENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D.
Contact information
Practice address
10314 FLORENCE CIR, LA VISTA, NE 68128-2372
(402) 504-9932
Mailing address
10314 FLORENCE CIR, LA VISTA, NE 68128-2372
(402) 504-9932
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
13121
NE
183500000X
Pharmacist
Primary
2007028067
MO
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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