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General NPI Number Information
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NPI Number | 1831267194
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Entity Type | Individual
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Provider Name | SHANNON KAYE KULICK PHARM D.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1450 W CHICAGO BLVD
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City | TECUMSEH
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State | MI
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Zip | 49286-8727
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Country | US
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Telephone | 517-424-1212
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Fax | 517-424-1213
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Provider Business Mailing Address
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Address Line | 1150 PADDOCK PL APT 104
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City | ANN ARBOR
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State | MI
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Zip | 48108-2816
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Country | US
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Telephone | 734-377-8030
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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 | 5302034363
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License Number State | MI
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