Individual
COLIE FULMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22 RIVER ST, PEAK, SC 29122
(803) 345-1707
Mailing address
1908 CLARK RD, LITTLE MOUNTAIN, SC 29075-8736
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11522
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11522
PHARMACY LIC.
SC
Enumeration date
02/28/2019
Last updated
02/28/2019
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