Healthcare Provider Details

I. General information

NPI: 1972002822
Provider Name (Legal Business Name): CICI PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BROAD AVE
PALISADES PARK NJ
07650-1509
US

IV. Provider business mailing address

333 CENTRAL AVE
METUCHEN NJ
08840-1230
US

V. Phone/Fax

Practice location:
  • Phone: 201-242-1000
  • Fax:
Mailing address:
  • Phone: 570-590-7819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SOLTAN CANGOZ
Title or Position: OWNER/ PARTNER
Credential: PHARMD
Phone: 570-590-7819