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General NPI Number Information
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NPI Number | 1548882889
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Entity Type | Individual
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Provider Name | JEREMIAH HICKS PHARM D
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Gender | Male
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Dates
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Enumeration Date | 05/09/2020
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Last Update Date | 05/09/2020
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Provider Practice Location Address
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Address Line | 4309 CONNECTICUT AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20008-2305
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Country | US
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Telephone | 202-966-3023
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Fax | 202-364-1202
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Provider Business Mailing Address
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Address Line | 2304 LAKEWOOD ST
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City | SUITLAND
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State | MD
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Zip | 20746-1419
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Country | US
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Telephone | 302-399-4259
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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 | PH100001943
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License Number State | DC
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