Justine Fullenwider, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS56493 Issued in FL

Practice address

11782 Martin Luther King Blvd E
Seffner, FL 33584-4923

Phone

(813) 643-0016

NPI assigned

Jan 5, 2017

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Publix Super Markets Inc

  • Community/Retail Pharmacy
  • Seffner, FL
  • NPI 1225584824
  NPD (past)
• Publix Super Markets Inc

  • Community/Retail Pharmacy
  • Winter Haven, FL
  • NPI 1760356380
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1861937484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11782 MARTIN LUTHER KING BLVD E",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335844923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11782 MARTIN LUTHER KING BLVD E",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335844923",
            "telephone_number": "813-643-0016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11667 Boyette Rd",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335695531",
            "country_code": "US",
            "telephone_number": "813-672-2744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLENWIDER",
        "first_name": "JUSTINE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS56493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foot & Ankle of Tampa Bay, PLLC
• Zachary Ford
• Verona C Fowles, RN
• Gabrielle Beth Frankenfield, ARNP
• Samantha Frazier
• Ihala L Garcia Quintana Mosqueda
• Adam Gardner
• Gabriela De la Caridad Gardon Mena
• Lakhabhai D Gedia, M.D.
• Meera Ghayal, D.O.

• All providers in Seffner, FL
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.