Provider Demographics
NPI:1154341394
Name:FULLER, DENNIS KEITH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KEITH
Last Name:FULLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 SPANISH WELLS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-5545
Mailing Address - Country:US
Mailing Address - Phone:702-656-2238
Mailing Address - Fax:
Practice Address - Street 1:2300 S RANCHO DR
Practice Address - Street 2:205
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4506
Practice Address - Country:US
Practice Address - Phone:702-383-2691
Practice Address - Fax:702-388-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103821835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy