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General NPI Number Information
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NPI Number | 1376146779
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Entity Type | Individual
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Provider Name | JACOB SICINSKI PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 13000 WARWICK BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-8340
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Country | US
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Telephone | 757-269-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 BATTERY BLVD APT 202
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-4758
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Country | US
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Telephone | 815-651-0167
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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 | 0202215778
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License Number State | VA
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