Provider Demographics
NPI:1598913634
Name:LICAUSI, CHERYL D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:D
Last Name:LICAUSI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LONGVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076
Mailing Address - Country:US
Mailing Address - Phone:603-635-9598
Mailing Address - Fax:603-437-1957
Practice Address - Street 1:123 NASHUA RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-437-8100
Practice Address - Fax:603-437-1957
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR18441835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist