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NPI Code Detail

MEDICARE: DR. KARISA LACY CICCHELLA PHARMD

MEDICARE: DR. KARISA LACY CICCHELLA PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS52576FL

General Provider Information

NPI Number : 1063813939
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KARISA LACY CICCHELLA PHARMD
Provider Business Mailing Address
First Line : 2175 W DOLPHIN DR
Second Line :
City : ENGLEWOOD
State : FL
Zip : 34223-6310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13435 S MCCALL RD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33981-6422
Country : US
Telephone Number : 941-697-3255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2014
Last Update Date : 09/10/2014

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