Provider Demographics
NPI:1922324458
Name:KICINSKI, GINA M
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:KICINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 ERWIN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4589
Mailing Address - Country:US
Mailing Address - Phone:919-282-5553
Mailing Address - Fax:
Practice Address - Street 1:2816 ERWIN RD STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4589
Practice Address - Country:US
Practice Address - Phone:919-282-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-035896L183500000X
NC13693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist