=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972609980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA ANN HICKEY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 EAST AVE
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-227-5153
-----------------------------------------------------
Fax | 561-845-7993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1419 BETA CT N
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-7807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-358-4124
-----------------------------------------------------
Fax | 561-582-5056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21700
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------