Jacob Fulton, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051.292753 Issued in IL

Practice address

12300 South Illinois Route 47
Huntley, IL 60142-9634

NPI assigned

Oct 30, 2020

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1093315814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12490 GLAZIER ST",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601426075",
            "telephone_number": "563-340-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 SOUTH ILLINOIS ROUTE 47",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601429634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12300 S Il Route 47",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429634",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12300 S IL route 47",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429634",
            "country_code": "US",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULTON",
        "first_name": "JACOB",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.292753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Huntley, IL
• Providers in Huntley, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.