Johnathan T Fuller, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

015034 Issued in KY

Practice address

2318 Frederica St
Owensboro, KY 42301-4826

Phone

(270) 686-7873

Fax

(270) 686-7864

NPI assigned

Sep 23, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midtown Pharmacy Express, LLC

  • Community/Retail Pharmacy
  • Beaver Dam, KY
  • NPI 1932442266
  NPD Authorized official
• Walgreen Co

  • Pharmacy
  • Owensboro, KY
  • NPI 1124033378
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1003199233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2318 FREDERICA ST",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423014826",
            "telephone_number": "270-686-7873",
            "fax_number": "270-686-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2318 FREDERICA ST",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423014826",
            "telephone_number": "270-686-7873",
            "fax_number": "270-686-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JOHNATHAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-23",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "015034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Hugh Fulkerson, MAE, LPCC
• Shana Fulkerson, CSW
• Allie Shea Fuller
• Haley Marie Fuller, APRN
• Heather Fuller, PHARMD, MBA
• Lindsey Fuller, SLP
• Mary Marie Fuqua, B.S.
• Thomas Greene Furgason IV, MD
• Lydia Fusco
• Leigh Ann Futrell, ARNP

• All providers in Owensboro, KY
• Pharmacist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.