Healthcare Provider Details

I. General information

NPI: 1841515624
Provider Name (Legal Business Name): DOUGLAS PAUL CICHON R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CLOVER FIELD DR
ALBANY NY
12211-1927
US

IV. Provider business mailing address

48 CLOVER FIELD DR
ALBANY NY
12211-1927
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1237
  • Fax: 518-525-1914
Mailing address:
  • Phone: 518-525-1237
  • Fax: 518-525-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038805-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: