Individual
BRENT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
339 9TH AVE SW, LAFAYETTE, AL 36862-2896
(334) 864-7781
Mailing address
339 9TH AVE SW, LAFAYETTE, AL 36862-2896
(334) 864-7781
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13653
AL
Other
Enumeration date
01/11/2021
Last updated
01/11/2021
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