Provider Demographics
NPI:1174908701
Name:GULICK, KELSI
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
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 1:3484 COUNTY ROAD 2730
Mailing Address - Street 2:
Mailing Address - City:BIGFOOT
Mailing Address - State:TX
Mailing Address - Zip Code:78005-3800
Mailing Address - Country:US
Mailing Address - Phone:830-334-7646
Mailing Address - Fax:
Practice Address - Street 1:225 S INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6630
Practice Address - Country:US
Practice Address - Phone:830-334-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist