Organization
ST OF MO FULTON ST HOSP
Active
Other names
FULTON STATE HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
600 E 5TH ST, FULTON, MO 65251-1753
(573) 592-3062
(573) 592-3070
Mailing address
600 E 5TH ST, FULTON, MO 65251-1753
(573) 592-3062
(573) 592-3070
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
001897
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2049691
PK
—
Enumeration date
02/06/2007
Last updated
08/31/2020
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