Provider Demographics
NPI:1730435306
Name:FULLER, NATASHA LAUREN (PHARMD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LAUREN
Last Name:FULLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 ROUTE 211 E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2117
Mailing Address - Country:US
Mailing Address - Phone:845-344-6215
Mailing Address - Fax:845-344-5780
Practice Address - Street 1:399 ROUTE 211 E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2117
Practice Address - Country:US
Practice Address - Phone:845-344-6215
Practice Address - Fax:845-344-5780
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist