Healthcare Provider Details

I. General information

NPI: 1750550364
Provider Name (Legal Business Name): JOHN JOSEPH CIECKA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N MACDADE BLVD
GLENOLDEN PA
19036-1224
US

IV. Provider business mailing address

2240 ACADEMY DR
BENSALEM PA
19020-3687
US

V. Phone/Fax

Practice location:
  • Phone: 610-522-0111
  • Fax:
Mailing address:
  • Phone: 610-522-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030547L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: