MEDICARE: MRS. AMY KATHRYN GULICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0044136	NY

General Provider Information

NPI Number	:	1174791685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY KATHRYN GULICK

Provider Business Mailing Address
First Line	:	23 BRIMFIELD CIR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8966
Country	:	US
Telephone Number	:	585-425-1842
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 FAIRPORT NINE MILE PT RD
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8509
Country	:	US
Telephone Number	:	585-377-1196
Fax Number	:	585-377-1196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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