Provider Demographics
NPI:1831267194
Name:KULICK, SHANNON KAYE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KAYE
Last Name:KULICK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 PADDOCK PL
Mailing Address - Street 2:APT 104
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2816
Mailing Address - Country:US
Mailing Address - Phone:734-377-8030
Mailing Address - Fax:
Practice Address - Street 1:1450 W CHICAGO BLVD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-8727
Practice Address - Country:US
Practice Address - Phone:517-424-1212
Practice Address - Fax:517-424-1213
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist