Individual
KIM FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1412 N WOODLAWN BLVD, DERBY, KS 67037-2922
(316) 788-5533
(316) 788-7432
Mailing address
1412 N WOODLAWN BLVD, DERBY, KS 67037-2922
(316) 788-5533
(316) 788-7432
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2-07913
KS
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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