Provider Demographics
NPI:1932532751
Name:CICHOCKI, NATHAN PAUL (RPH)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PAUL
Last Name:CICHOCKI
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:W3208 VAN ROY RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4086
Mailing Address - Country:US
Mailing Address - Phone:920-733-3846
Mailing Address - Fax:
Practice Address - Street 1:W3208 VAN ROY RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4086
Practice Address - Country:US
Practice Address - Phone:920-733-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17141-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist