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General NPI Number Information
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NPI Number | 1780625897
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Entity Type | Individual
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Provider Name | JAMES L. HICKS, III RPH
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3160 AUDUBON DR
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City | LAUREL
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State | MS
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Zip | 39440-1926
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Country | US
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Telephone | 601-428-0688
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Fax | 601-428-0689
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Provider Business Mailing Address
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Address Line | 418 W 27TH ST
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City | LAUREL
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State | MS
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Zip | 39440-1724
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Country | US
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Telephone | 601-428-0688
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Fax | 601-428-0689
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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 | E6030
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License Number State | MS
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