Provider Demographics
NPI:1598280430
Name:CICCONE, CHRISTINA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:CICCONE
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 1:8403 TAPESTRY CIR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-8309
Mailing Address - Country:US
Mailing Address - Phone:614-315-3445
Mailing Address - Fax:
Practice Address - Street 1:6620 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3045
Practice Address - Country:US
Practice Address - Phone:502-231-1310
Practice Address - Fax:502-231-1827
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027152A183500000X
KY019382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist