MEDICARE: DR. JEREMIAH HICKS PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH100001943	DC

General Provider Information

NPI Number	:	1548882889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMIAH HICKS PHARM D

Provider Business Mailing Address
First Line	:	2304 LAKEWOOD ST
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-1419
Country	:	US
Telephone Number	:	302-399-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 CONNECTICUT AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2305
Country	:	US
Telephone Number	:	202-966-3023
Fax Number	:	202-364-1202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2020
Last Update Date	:	05/09/2020

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