Healthcare Provider Details

I. General information

NPI: 1811650914
Provider Name (Legal Business Name): GINA MARIE CICCONE-KELLEY PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 10/16/2021
Certification Date: 10/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FREEPORT RD STE 1
PITTSBURGH PA
15238-6178
US

IV. Provider business mailing address

910 FREEPORT RD STE 1
PITTSBURGH PA
15238-6178
US

V. Phone/Fax

Practice location:
  • Phone: 412-781-1600
  • Fax: 412-781-6001
Mailing address:
  • Phone: 412-781-1600
  • Fax: 412-781-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP447779
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: