Individual
LINDA DIANNE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
324 BARON BLVD, SUFFOLK, VA 23435-2486
(757) 465-3476
Mailing address
324 BARON BLVD, SUFFOLK, VA 23435-2486
(757) 465-3476
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202004966
VA
Other
Enumeration date
09/27/2011
Last updated
09/27/2011
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