Healthcare Provider Details

I. General information

NPI: 1831267194
Provider Name (Legal Business Name): SHANNON KAYE KULICK PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W CHICAGO BLVD
TECUMSEH MI
49286-8727
US

IV. Provider business mailing address

1150 PADDOCK PL APT 104
ANN ARBOR MI
48108-2816
US

V. Phone/Fax

Practice location:
  • Phone: 517-424-1212
  • Fax: 517-424-1213
Mailing address:
  • Phone: 734-377-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034363
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: