Healthcare Provider Details

I. General information

NPI: 1568280659
Provider Name (Legal Business Name): EMILY FICCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/28/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 KLINE VLG
HARRISBURG PA
17104-1581
US

IV. Provider business mailing address

6 WHEATLAND DR
MYERSTOWN PA
17067-3172
US

V. Phone/Fax

Practice location:
  • Phone: 717-909-0703
  • Fax:
Mailing address:
  • Phone: 717-639-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP458805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: