Healthcare Provider Details

I. General information

NPI: 1720534084
Provider Name (Legal Business Name): GILBERT ULLRICH I PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9133 KIEFER BLVD
SACRAMENTO CA
95826-5105
US

IV. Provider business mailing address

357 HANSEN CIRCLE FOLSOM
FOLSOM CA
95630
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-1384
  • Fax: 916-366-7861
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number39707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: