Provider Demographics
NPI:1861990186
Name:FULLER, FRANK BERNARD III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:BERNARD
Last Name:FULLER
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6900 ATMORE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5644
Mailing Address - Country:US
Mailing Address - Phone:804-887-8218
Mailing Address - Fax:
Practice Address - Street 1:6900 ATMORE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5644
Practice Address - Country:US
Practice Address - Phone:804-887-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022127731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202212773OtherSTATE LICENSE