Healthcare Provider Details

I. General information

NPI: 1649701806
Provider Name (Legal Business Name): ALICIA CICINELLI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

12209 WARD RD
CHESANING MI
48616-9515
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032528
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: