Provider Demographics
NPI:1265466502
Name:VINCENT J KULUZ
Entity type:Organization
Organization Name:VINCENT J KULUZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:KULUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-432-5581
Mailing Address - Street 1:1053 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-3776
Mailing Address - Country:US
Mailing Address - Phone:228-432-5581
Mailing Address - Fax:228-432-5577
Practice Address - Street 1:1053 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-3776
Practice Address - Country:US
Practice Address - Phone:228-432-5581
Practice Address - Fax:228-432-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE4054183500000X
MS001073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00039390Medicaid