Fulton Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

5301005576 Issued in MI

Legal business name

FULTON PHARMACY INC

Practice address

738 W Fulton St
Grand Rapids, MI 49504-6320

Phone

(616) 293-1258

NPI assigned

Oct 19, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Suzanne Nash Anthony, RPH

Title

Vice President

Phone

(616) 791-2014

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandra M Kausch, RPH

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1467584607
  NPD (past)
• Suzanne Rae Lake, RPH

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1851545008
  NPD (past)

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1093704371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4291 MOHAVE CT SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181739",
            "telephone_number": "616-293-1258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 W FULTON ST",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495046320",
            "telephone_number": "616-293-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULTON PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "ANTHONY",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "NASH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "616-791-2014",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301005576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4734275",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "2348678",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2348678",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renee Michelle Fuller, LMSW
• Thomas Charles Fuller, PHD
• Kerianne Fullin, MD/MPH
• Shelby Fullington
• Robert Dylan Fulmer, DO
• Clifford Thomas Fulton, MD
• Functional Innovative Therapy, LLC
• Bryan Andrew Funk, MA
• Theresa Funk, LBSW
• Charlie Furister

• Pharmacy in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.