Provider Demographics
NPI:1801536289
Name:GULLICKSON, KADEE COLLEEN (PHARMD)
Entity type:Individual
Prefix:
First Name:KADEE
Middle Name:COLLEEN
Last Name:GULLICKSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:HOOPLE
Mailing Address - State:ND
Mailing Address - Zip Code:58243-0111
Mailing Address - Country:US
Mailing Address - Phone:701-331-9243
Mailing Address - Fax:
Practice Address - Street 1:503 PARK ST W
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-4137
Practice Address - Country:US
Practice Address - Phone:701-284-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist