Healthcare Provider Details

I. General information

NPI: 1447669411
Provider Name (Legal Business Name): GAYLE HICKS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 N KANSAS EXPY
SPRINGFIELD MO
65803-1114
US

IV. Provider business mailing address

2625 N KANSAS EXPY
SPRINGFIELD MO
65803-1114
US

V. Phone/Fax

Practice location:
  • Phone: 417-869-9003
  • Fax: 417-869-0277
Mailing address:
  • Phone: 417-869-9003
  • Fax: 417-869-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: