Provider Demographics
NPI:1821313347
Name:CICHELLO, MONA ANASTAZIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:ANASTAZIE
Last Name:CICHELLO
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 1:36 GYPSY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STUYVESANT
Mailing Address - State:NY
Mailing Address - Zip Code:12173-2904
Mailing Address - Country:US
Mailing Address - Phone:518-799-2146
Mailing Address - Fax:518-799-2106
Practice Address - Street 1:36 GYPSY ROCK RD
Practice Address - Street 2:
Practice Address - City:STUYVESANT
Practice Address - State:NY
Practice Address - Zip Code:12173-2904
Practice Address - Country:US
Practice Address - Phone:518-799-2146
Practice Address - Fax:518-799-2106
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist