Basic Information
| Provider Information | |||||||||
| NPI: | 1841643194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FULKS | ||||||||
| FirstName: | KATIE | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7461 BLACKMON RD | ||||||||
| Address2: | APT 4511 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319098400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483421655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065711000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2016 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH029314 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.