Healthcare Provider Details

I. General information

NPI: 1992816037
Provider Name (Legal Business Name): HICKS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RICHLAND AVE W
AIKEN SC
29801-3224
US

IV. Provider business mailing address

1020 RICHLAND AVE W
AIKEN SC
29801-3224
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-7437
  • Fax: 803-649-2062
Mailing address:
  • Phone: 803-649-7437
  • Fax: 803-649-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8778
License Number StateSC

VIII. Authorized Official

Name: KATHERINE MC GILL HICKS
Title or Position: PIC CORP OFFICER
Credential: RPH
Phone: 803-649-7437