Provider Demographics
NPI:1144823139
Name:FULTON, JUDY RECTOR
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:RECTOR
Last Name:FULTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10346 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1710
Mailing Address - Country:US
Mailing Address - Phone:540-710-9314
Mailing Address - Fax:540-710-9190
Practice Address - Street 1:10346 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1710
Practice Address - Country:US
Practice Address - Phone:540-710-9314
Practice Address - Fax:540-710-9190
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist