Renate Selene Fuller, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

048137 Issued in NY

Practice address

518 Jefferson PLZ
Port Jefferson Station, NY 11776-1104

Phone

(631) 476-8334

Fax

(631) 476-0749

NPI assigned

Dec 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252195200000",
    "number": "1184807117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5145 NESCONSET HWY",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762047",
            "telephone_number": "631-331-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 JEFFERSON PLZ",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761104",
            "telephone_number": "631-476-8334",
            "fax_number": "631-476-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "RENATE",
        "middle_name": "SELENE",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-13",
        "last_updated": "2009-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "048137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01869410",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodi Friedberg, RN
• Dawn Friedland-Perez, LCSW
• Eugene N Friedman, RPH
• Christine M Fruth Giacobbe, D.O.
• John C Fuhr, R.N.
• Ann-Marie Furman, M.S. CCC SLP
• Lara Michaela Jude Fusco, PA-C
• Meaghan Catherine Gallery
• Franco Gallo, MD
• Richard Steven Gambino, DDS

• Pharmacist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2009; 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.