Individual provider Active NPI

Donald J Fulkert, RPH

  • Pharmacist
  • Oregon, OH
National Provider Identifier
1306414792
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
03216683 Issued in OH
Practice address
2600 Navarre Ave
Oregon, OH 43616-3207
Phone
(419) 696-7595
NPI assigned
Jun 14, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 03216683 OH Primary

Addresses

Primary practice location

2600 Navarre Ave
Oregon, OH 43616-3207

Mailing address

809 Main St
Genoa, OH 43430-1637
Phone (419) 855-4091

Other identifiers 1

IdentifierTypeStateIssuer
360081MedicaidOH

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
03216683OHMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1306414792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 MAIN ST",
            "city": "GENOA",
            "state": "OH",
            "postal_code": "434301637",
            "telephone_number": "419-855-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 NAVARRE AVE",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436163207",
            "telephone_number": "419-696-7595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKERT",
        "first_name": "DONALD",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03216683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360081",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.