Provider Demographics
NPI:1194002667
Name:KUNICK, TERRY S (RPH)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:S
Last Name:KUNICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:WI
Mailing Address - Zip Code:54670-6006
Mailing Address - Country:US
Mailing Address - Phone:608-577-3421
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE STE 800
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3695
Practice Address - Country:US
Practice Address - Phone:800-553-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8447-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist