Provider Demographics
NPI:1871686188
Name:KOTULSKY, GAIL LYNN
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LYNN
Last Name:KOTULSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 WEST TARPON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-624-5712
Mailing Address - Fax:
Practice Address - Street 1:3280 TAMIAMI TRAIL
Practice Address - Street 2:WINN DIXIE PHARMACY
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-625-2518
Practice Address - Fax:941-625-2545
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTCB180107861717528183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050786Medicare ID - Type Unspecified