| Doctor Name: | MR. LARRY CICERO |
| NPI Number: | 1447615620 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPH |
| License Number: | RP029969L |
| Business Practice Address: | 1333 Plank Rd Duncansville, PA - 166358456 |
| Business Phone Number: | 8552658008 |
| Business Fax Number: | 8142832211 |
| Mailing Address: | 1333 Plank Rd, DUNCANSVILLE |
| State: | PA |
| Postal Code: | 166358456 |
| Phone Number: | 8552658008 |
| Fax Number: | 8142832211 |
| NPI Enumeration Date: | 12/15/2015 |
| NPI Last Update Date: | 12/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | RP029969L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |