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General NPI Number Information
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NPI Number | 1205434289
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Entity Type | Individual
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Provider Name | LISA CICHOCKI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 2440 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4711
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Country | US
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Telephone | 920-499-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 4066 HUDSON HILL DR
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City | HOBART
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State | WI
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Zip | 54155-8984
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Country | US
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Telephone | 920-664-4114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17594-40
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License Number State | WI
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