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NPI Code Detail

MEDICARE: MRS. SUSAN VANDERWERF HICKS RPH

MEDICARE: MRS. SUSAN VANDERWERF HICKS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS19596FL

General Provider Information

NPI Number : 1932361896
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN VANDERWERF HICKS RPH
Provider Business Mailing Address
First Line : 400 AUDUBON DR
Second Line :
City : MIRAMAR BEACH
State : FL
Zip : 32550-4594
Country : US
Telephone Number : 850-267-6767
Fax Number :
Provider Business Practice Location Address
First Line : 400 AUDUBON DR
Second Line :
City : MIRAMAR BEACH
State : FL
Zip : 32550-4594
Country : US
Telephone Number : 850-267-6767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2008
Last Update Date : 07/15/2014

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Directions to “ MRS. SUSAN VANDERWERF HICKS RPH” Practice Location

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