Provider Demographics
NPI:1053208355
Name:MAJOR, CICELY
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:MAJOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 CHARLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2303
Mailing Address - Country:US
Mailing Address - Phone:803-391-9206
Mailing Address - Fax:
Practice Address - Street 1:1532 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8622
Practice Address - Country:US
Practice Address - Phone:803-732-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC60614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist