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General NPI Number Information
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NPI Number | 1902874365
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Entity Type | Individual
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Provider Name | LISA BOCK HICKS RPH
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8452 118 AVENUE N.
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City | LARGO
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State | FL
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Zip | 33773
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Country | US
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Telephone | 727-395-6585
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 LAKE RIDGE DR
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-5620
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Country | US
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Telephone | 727-797-5163
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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 | PS21581
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10698
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License Number State | AL
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