Fuller Selle LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

Y004869 Issued in AZ

Legal business name

FULLER SELLE LLC

Practice address

215 S Power Rd
Mesa, AZ 85206-5235

Phone

(408) 985-6992

NPI assigned

Jun 30, 2008

Organization subpart

No

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

Authorized official

Name

Gary Alexander

Title

Cfo

Phone

(210) 745-4000

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• TRILLIUM SPECIALTY HOSPITAL EAST VALLEY Doing business as

Tax ID family

Fuller Selle LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Fuller Selle LLC

  • Long Term Care Pharmacy
  • Sun City, AZ
  • NPI 1861654964
  NPD tax ID
• Fuller-Selle, LLC

  • Pharmacy
  • San Antonio, TX
  • NPI 1821257759
  NPD tax ID

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1053573154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 E SONTERRA BLVD",
            "address_2": "STE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 S POWER RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852065235",
            "telephone_number": "408-985-6992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLER SELLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "210-745-4000"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AZ",
            "license": "Y004869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0355392",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRILLIUM SPECIALTY HOSPITAL EAST VALLEY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyssa A Fukumae, PT, DPT
• Jeanne Dalene Fulcher, N.N.P.
• William C Fulcher, D.D.S.
• Sabrina Fulghum, MSW
• Full Circle Health Center LLC
• Aurelia Fuller, OTRL
• Charmaine Fuller
• Jessica Fuller, RBT
• Justin Wayne Fuller
• Kisti Pope Fuller, MD

• Long Term Care Pharmacy in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Long Term Care Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.