Provider Demographics
NPI:1578847083
Name:ZULICK, RICHARD MAURER (R PH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MAURER
Last Name:ZULICK
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 PINES RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-5206
Mailing Address - Country:US
Mailing Address - Phone:318-631-9804
Mailing Address - Fax:318-631-9826
Practice Address - Street 1:3620 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-5206
Practice Address - Country:US
Practice Address - Phone:318-631-9804
Practice Address - Fax:318-631-9826
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist