Provider Demographics
NPI:1922330836
Name:KULLE, MARYJEAN KATHERINE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARYJEAN
Middle Name:KATHERINE
Last Name:KULLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 OSWEGO RD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2900
Mailing Address - Country:US
Mailing Address - Phone:315-652-6584
Mailing Address - Fax:315-622-5622
Practice Address - Street 1:7608 OSWEGO RD
Practice Address - Street 2:SUITE 19
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2900
Practice Address - Country:US
Practice Address - Phone:315-652-6584
Practice Address - Fax:315-622-5622
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist