Basic Information
| Provider Information | |||||||||
| NPI: | 1477204477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SICA | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | VINCENT | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 HUCKLEBERRY LN | ||||||||
| Address2: | |||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064894319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603291699 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24 HAMILTON ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128664226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2022 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 068277 | NY | N | Pharmacy Service Providers | Pharmacist | 183500000X | PCT.0015272 | CT | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.