1912330374 NPI number — MISS CASSANDRA MARIE CICHY PHARMD

Table of content: MISS CASSANDRA MARIE CICHY PHARMD (NPI 1912330374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912330374 NPI number — MISS CASSANDRA MARIE CICHY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CICHY
Provider First Name:
CASSANDRA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912330374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4810 WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53406-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-635-0181
Provider Business Mailing Address Fax Number:
262-635-1865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 MONUMENT SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53403-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-635-0520
Provider Business Practice Location Address Fax Number:
262-632-6777
Provider Enumeration Date:
08/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17178-40 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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