Healthcare Provider Details

I. General information

NPI: 1497992093
Provider Name (Legal Business Name): PATRICIA ANN CICERO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHESFIELD LOOKOUT
FAIRPORT NY
14450-9707
US

IV. Provider business mailing address

11 CHESFIELD LOOKOUT
FAIRPORT NY
14450-9707
US

V. Phone/Fax

Practice location:
  • Phone: 585-223-7842
  • Fax:
Mailing address:
  • Phone: 585-223-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042808
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: