Active NPI
Jill Anne Fullerton, RPH
- Pharmacist
- Enumclaw, WA
National Provider Identifier
1952466252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13637
- Practice address
- 1269 McKinley St
Enumclaw, WA 98022-2106 - Phone
- (360) 825-5525
- Fax
- (360) 825-5525
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13637 | WA | Primary |
Addresses
Primary practice location
1269 McKinley St
Enumclaw, WA 98022-2106
Mailing address
1269 McKinley St
Enumclaw, WA 98022-2106
Phone (360) 825-5525
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13637 | Other | WA | PHARMACIST LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 13637 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952466252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1269 MCKINLEY ST",
"city": "ENUMCLAW",
"state": "WA",
"postal_code": "980222106",
"telephone_number": "360-825-5525",
"fax_number": "360-825-5525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1269 MCKINLEY ST",
"city": "ENUMCLAW",
"state": "WA",
"postal_code": "980222106",
"telephone_number": "360-825-5525",
"fax_number": "360-825-5525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLERTON",
"first_name": "JILL",
"middle_name": "ANNE",
"name_prefix": "Miss",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "13637",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "13637",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Enumclaw, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.