Healthcare Provider Details

I. General information

NPI: 1952666208
Provider Name (Legal Business Name): MARK CATLETT CIFELLI PHARMD, BCPS, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 06/06/2020
Certification Date: 06/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 AIRPORT RD APT 512
DESTIN FL
32541-2829
US

IV. Provider business mailing address

955 AIRPORT RD APT 1223
DESTIN FL
32541-2818
US

V. Phone/Fax

Practice location:
  • Phone: 908-698-1751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03480300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH027432
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51230
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212550
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3155664
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number6151587
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: