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General NPI Number Information
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NPI Number | 1457609489
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Entity Type | Individual
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Provider Name | CHARLES I HICKS R.PH.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2012
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 9807 BEACHVIE DR
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City | JEROME
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State | MI
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Zip | 49249-9551
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Country | US
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Telephone | 517-688-4520
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Fax |
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Provider Business Mailing Address
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Address Line | 9807 BEACHVIEW DR
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City | JEROME
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State | MI
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Zip | 49249-9551
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Country | US
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Telephone | 517-688-4520
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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 | 03210063
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License Number State | OH
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