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General NPI Number Information
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NPI Number | 1184874711
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Entity Type | Individual
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Provider Name | PAUL ANTHONY WALICKE RPH
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Gender | Male
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 851 IRELAND AVE IRELAND ARMY COMMUNITY HOSPITAL
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City | FORT KNOX
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State | KY
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Zip | 40121-2722
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Country | US
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Telephone | 502-624-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 817 PALOMINO LN
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City | LEXINGTON
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State | KY
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Zip | 40503-5458
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Country | US
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Telephone | 859-523-5475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 013884
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License Number State | KY
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