FULLER SELLE LLC (NPI# 1053573154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053573154 |
| Entity Type | Organization |
| Organization Name | FULLER SELLE LLC |
| Other Organization Name | TRILLIUM SPECIALTY HOSPITAL EAST VALLEY |
| Practice Address |
215 S Power Rd Mesa AZ 85206-5235 |
| Mailing Address |
777 E Sonterra Blvd Ste 300 San Antonio TX 78258-4246 |
| Practice Telephone | 4089856992 |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2008-06-30 |
| Authorized Official Name | GARY ALEXANDER (CFO) |
| Authorized Official Telephone | 2107454000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Y004869 | AZ | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER | 0355392 | 01 |
| Other Name | Type Code |
|---|---|
| TRILLIUM SPECIALTY HOSPITAL EAST VALLEY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861654964 | Fuller Selle LLC | Pharmacy | 13818 N Thunderbird Blvd, Sun City, AZ 85351-2574 | 2008-06-30 |
| Street Address |
215 S POWER RD |
| City | MESA |
| State | AZ |
| Zip Code | 85206-5235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245228170 | Hearthstone Hospital Mesa | Long Term Care Hospital | 215 S Power Rd, Mesa, AZ 85206-5235 | 2005-10-13 |
| 1649643172 | Laura Lamb | Massage Therapist | 215 S Power Rd, Mesa, AZ 85206-5235 | 2015-11-05 |
| 1881067627 | Living Younger Movment Therapy, LLC | Massage Therapist | 215 S Power Rd, Mesa, AZ 85206-5235 | 2015-11-02 |
| 1710318019 | Healthy Kidz Pediatrics LLC | Pediatrics | 215 S Power Rd, Suite # 106, Mesa, AZ 85206-5235 | 2013-12-12 |
| 1487914727 | Restora Hospital of Mesa, LLC | Long Term Care Hospital | 215 S Power Rd, Mesa, AZ 85206-5235 | 2012-05-21 |
| 1871853119 | Restora Hospital of Mesa, LLC | Skilled Nursing Facility | 215 S Power Rd, Mesa, AZ 85206-5235 | 2012-05-21 |
| 1790044071 | Acuity Specialty Hospital of Arizona At Mesa LLC | Skilled Nursing Facility | 215 S Power Rd, Mesa, AZ 85206-5235 | 2012-05-08 |
| 1407114127 | Acuity Specialty Hospital of Arizona At Mesa, LLC | Long Term Care Hospital | 215 S Power Rd, Mesa, AZ 85206-5235 | 2012-05-01 |
| 1932491628 | Stephen L Burton | Mechanotherapist | 215 S Power Rd, Ste. 105, Mesa, AZ 85206-5235 | 2011-05-12 |
| 1558681098 | Berni Massari | Homeopath | 215 S Power Rd, Power Medical Center Suite 105, Mesa, AZ 85206-5235 | 2010-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720693062 | Inner Balance Counseling LLC | Counselor | 4111 E Auto Valley Drive, Suite 101, Mesa, AZ 85206 | 2020-09-14 |
| 1356978969 | Choices 4 Change Counseling and Coaching LLC | Social Worker | 3707 E Southern Ave., Suite 2027, Mesa, AZ 85206 | 2020-03-24 |
| 1023651288 | Jason Mcclure | Hearing Instrument Specialist | 5540 E Broadway Rd., Mesa, AZ 85206 | 2019-10-21 |
| 1255995361 | Vhs of Phoenix Inc | General Acute Care Hospital | 5750 E. Baseline Rd., Mesa, AZ 85206 | 2019-04-24 |
| 1932682184 | Adam Fishel Frose | Psychologist | 4555 E Inverness Ave Ste 112, Mesa, AZ 85206 | 2018-09-13 |
| 1376024737 | Robyn Kathleen Hall | Psychologist | 4115 East Valley Auto Drive, Suite 208, Mesa, AZ 85206 | 2018-08-23 |
| 1790264984 | Perspective Health, LLC | Clinic/Center | 1959 S. Power Rd, Suite 103, #206, Mesa, AZ 85206 | 2018-08-09 |
| 1033605159 | Rebecca Ann Maro | Nurse Practitioner | 6750 E Baywood Ave Ste 502, Mesa, AZ 85206 | 2018-07-02 |
| 1982195624 | Spark Performance and Physiotherapy | Clinic/Center | 6056 East Basline Road, Suite 147, Mesa, AZ 85206 | 2018-05-29 |
| 1336645993 | Ashley Wright | Audiologist-Hearing Aid Fitter | 1423 S Higley Rd Ste 119, Mesa, AZ 85206 | 2018-04-03 |
| Find all providers in zip 85206 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912312315 | East Valley Patient Care Services | Pharmacy | 218 W Hampton Ave, #4, Mesa, AZ 85210-5231 | 2014-06-24 |
| 1023369386 | Genoa Healthcare, LLC | Pharmacy | 1705 W Main St, Mesa, AZ 85201-6920 | 2012-09-27 |
| 1922367952 | Genoa Healthcare, LLC | Pharmacy | 1255 W Baseline Rd, Ste 138, Mesa, AZ 85202-5820 | 2012-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336749860 | Adepa Pharmacy Pllc | Pharmacy | 8770 N Thornydale Rd, Tucson, AZ 85742-9096 | 2020-10-26 |
| 1801493705 | Cd Pharmacy LLC | Pharmacy | 2710 S Roosevelt St, Tempe, AZ 85282-2089 | 2020-10-04 |
| 1326695545 | Lifecare Pharmacy Yuma LLC | Pharmacy | 2514 South Ave A, Suite 2, Yuma, AZ 85365 | 2019-08-22 |
| 1912366774 | Pharmcare Usa of Greater Phoenix LLC | Pharmacy | 1835 S Alvernon Way Ste 202, Tucson, AZ 85711-5693 | 2016-02-22 |
| 1710388384 | Pharmacy Care Provider LLC | Pharmacy | 1135 N Jefferson Ave, Tucson, AZ 85712-5009 | 2014-09-15 |
| 1235565581 | Guardian Pharmacy of Tucson LLC | Pharmacy | 10900 N Stallard Pl, Oro Valley, AZ 85737-9544 | 2013-09-18 |
| 1972944221 | Genoa Healthcare, LLC | Pharmacy | 1500 S White Mountain Rd, Bldg 3, Suite 302, Show Low, AZ 85901-7929 | 2013-07-16 |
| 1730422601 | Genoa Healthcare, LLC | Pharmacy | 10240 N 31st Ave Ste 210, Phoenix, AZ 85051-9565 | 2013-03-29 |
| 1093067670 | Genoa Healthcare, LLC | Pharmacy | 15317 W Bell Rd Ste 106, Suite 106, Surprise, AZ 85374-3901 | 2012-10-08 |
| 1811248479 | Palliative Pharmacy Partners LLC | Pharmacy | 1843 E Southern Ave, 102, Tempe, AZ 85282-5831 | 2012-09-24 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on FULLER SELLE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.