Provider Demographics
NPI:1447615620
Name:CICERO, LARRY (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:CICERO
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 1:1333 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8456
Mailing Address - Country:US
Mailing Address - Phone:855-265-8008
Mailing Address - Fax:814-283-2211
Practice Address - Street 1:1333 PLANK RD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8456
Practice Address - Country:US
Practice Address - Phone:855-265-8008
Practice Address - Fax:814-283-2211
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029969L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist