Provider Demographics
NPI:1750385423
Name:FULTON, CONCHETTA WHITE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:CONCHETTA
Middle Name:WHITE
Last Name:FULTON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SONIAT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2955
Mailing Address - Country:US
Mailing Address - Phone:504-899-3564
Mailing Address - Fax:504-895-3058
Practice Address - Street 1:1532 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2860
Practice Address - Country:US
Practice Address - Phone:504-903-6388
Practice Address - Fax:504-520-7971
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist