Healthcare Provider Details

I. General information

NPI: 1619570702
Provider Name (Legal Business Name): ANTHONY CICCARONE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 SPRING HILL DR
SPRING HILL FL
34609-4649
US

IV. Provider business mailing address

11115 SPRING HILL DR
SPRING HILL FL
34609-4649
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-1336
  • Fax:
Mailing address:
  • Phone: 352-686-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS22369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: