Provider Demographics
NPI:1972002822
Name:CICI PHARMACY
Entity type:Organization
Organization Name:CICI PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANGOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-590-7819
Mailing Address - Street 1:333 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1230
Mailing Address - Country:US
Mailing Address - Phone:570-590-7819
Mailing Address - Fax:
Practice Address - Street 1:210 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1509
Practice Address - Country:US
Practice Address - Phone:201-242-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy