Healthcare Provider Details

I. General information

NPI: 1154286342
Provider Name (Legal Business Name): NICHOLAS PICCICACCO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

2816 W WALLACE AVE
TAMPA FL
33611-4537
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4389
  • Fax:
Mailing address:
  • Phone: 941-919-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License NumberPS51888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: