Provider Demographics
NPI:1316537061
Name:CIANCIOLO, ALICIA MISHIRO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MISHIRO
Last Name:CIANCIOLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BRADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-1901
Mailing Address - Country:US
Mailing Address - Phone:864-373-5688
Mailing Address - Fax:
Practice Address - Street 1:3027 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2767
Practice Address - Country:US
Practice Address - Phone:864-292-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist