Provider Demographics
NPI:1831281781
Name:CICCONE, JOSEPH A (CPH, RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:CICCONE
Suffix:
Gender:M
Credentials:CPH, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 SE KIRK ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-1532
Mailing Address - Country:US
Mailing Address - Phone:321-574-0926
Mailing Address - Fax:
Practice Address - Street 1:1267 SE KIRK ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-1532
Practice Address - Country:US
Practice Address - Phone:321-574-0926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU55221835P1200X
FLPS23618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered183500000XPharmacy Service ProvidersPharmacist