Provider Demographics
NPI:1093069189
Name:HICKS, KIMBERLY MCLEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MCLEAN
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 S NORTH LAKE BLVD
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5261
Mailing Address - Country:US
Mailing Address - Phone:800-628-6965
Mailing Address - Fax:180-026-9549
Practice Address - Street 1:376 S NORTH LAKE BLVD
Practice Address - Street 2:SUITE 1008
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5261
Practice Address - Country:US
Practice Address - Phone:800-628-6965
Practice Address - Fax:180-026-9549
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1835P0018X1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist