Provider Demographics
NPI:1750550364
Name:CIECKA, JOHN JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:CIECKA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3687
Mailing Address - Country:US
Mailing Address - Phone:610-522-0111
Mailing Address - Fax:
Practice Address - Street 1:140 N MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1224
Practice Address - Country:US
Practice Address - Phone:610-522-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030547L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP030547LOtherPA PHARMACY BOARD