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General NPI Number Information
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NPI Number | 1073114971
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Entity Type | Individual
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Provider Name | ANGELIA DENISE HICKS
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Gender | Female
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 1851 HIGHWAY 192 W
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City | LONDON
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State | KY
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Zip | 40741-3032
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Country | US
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Telephone | 606-878-3041
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Fax | 600-877-3041
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Provider Business Mailing Address
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Address Line | 94 SULFER SPRINGS RD
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City | LONDON
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State | KY
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Zip | 40744-9704
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Country | US
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Telephone | 606-401-3032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 010271
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License Number State | KY
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