Healthcare Provider Details

I. General information

NPI: 1184872913
Provider Name (Legal Business Name): NANCY CICCARELLI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

184 COUNTY LINE RD
DANVILLE PA
17821-9153
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6907
  • Fax:
Mailing address:
  • Phone: 570-275-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP041743L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: