Healthcare Provider Details

I. General information

NPI: 1801239843
Provider Name (Legal Business Name): DANIEL ANTHONY CICHY PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 MILLER PARK WAY
WEST MILWAUKEE WI
53214-3604
US

IV. Provider business mailing address

1636 MILLER PARK WAY
WEST MILWAUKEE WI
53214-3604
US

V. Phone/Fax

Practice location:
  • Phone: 414-385-9500
  • Fax: 414-533-6601
Mailing address:
  • Phone: 414-385-9500
  • Fax: 414-533-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16916-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: