Daniel R Fuller Jr., PHARMD

Individual provider Active NPI Pharmacist · Moon Township, PA

NPI 1114479102 · NPPES record last updated Oct 26, 2016

Key facts

NPI
1114479102
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
RP449801 (PA)
Practice address
7500 Univsersity Blvd.
Moon Township, PA 15108
Phone
(412) 893-0143
NPI assigned
Oct 26, 2016
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RP449801PAMDPharmacist
RPI009891PAMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP449801 PA Yes
Pharmacist 183500000X RPI009891 PA

Addresses

Primary practice location

7500 Univsersity Blvd.
Moon Township, PA 15108

Mailing address

7500 Univsersity Blvd.
Moon Township, PA 15108
Phone (412) 893-0143

Other identifiers

IdentifierTypeStateIssuer
RPI009891OtherPAPENNSYLVANIA BOARD OF PHARMACY
RP449801OtherPAPENNSYLVANIA BOARD OF PHARMACY

Other providers in Moon Township, PA

All providers in Moon Township, PA · Pharmacist in Pennsylvania

Sources for this page

Verify at the official NPI Registry.