Individual
DR. MICHAEL WILLIAM LICAMELE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHARM. D.
Contact information
Practice address
35 ONTARIO ST, STRATFORD, CT 06615-7135
(203) 375-8000
(800) 784-5430
Mailing address
210 COBBLERS HILL RD, FAIRFIELD, CT 06824-2104
(203) 521-8439
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3893
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3893
LICENSE
CT
Enumeration date
11/18/2005
Last updated
07/08/2007
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