Healthcare Provider Details

I. General information

NPI: 1518381441
Provider Name (Legal Business Name): CHRISTOPHER CICUTO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HAZEN RD
SHARPSVILLE PA
16150-1713
US

IV. Provider business mailing address

730 HAZEN RD
SHARPSVILLE PA
16150-1713
US

V. Phone/Fax

Practice location:
  • Phone: 724-977-5382
  • Fax:
Mailing address:
  • Phone: 724-977-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP439517
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: