Provider Demographics
NPI:1629360052
Name:CIKOWSKI, DONNA MARIE (R PH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:CIKOWSKI
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 SPRINGER ST
Mailing Address - Street 2:MOOSIC
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1739
Mailing Address - Country:US
Mailing Address - Phone:570-963-8810
Mailing Address - Fax:
Practice Address - Street 1:1777 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1215
Practice Address - Country:US
Practice Address - Phone:570-346-2087
Practice Address - Fax:570-346-2388
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035910L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist