Provider Demographics
NPI:1265028732
Name:HICKS, LAMONICA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAMONICA
Middle Name:
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 1:101 NOTTING HILL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3832
Mailing Address - Country:US
Mailing Address - Phone:386-562-1921
Mailing Address - Fax:
Practice Address - Street 1:101 NOTTING HILL DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-3832
Practice Address - Country:US
Practice Address - Phone:386-562-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist