Provider Demographics
NPI:1174791685
Name:GULICK, AMY KATHRYN
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHRYN
Last Name:GULICK
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 1:23 BRIMFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8966
Mailing Address - Country:US
Mailing Address - Phone:585-425-1842
Mailing Address - Fax:
Practice Address - Street 1:2161 FAIRPORT NINE MILE PT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8509
Practice Address - Country:US
Practice Address - Phone:585-377-1196
Practice Address - Fax:585-377-1196
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0044136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist