Provider Demographics
NPI:1306017595
Name:HICKS, JON GARY (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:GARY
Last Name:HICKS
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 THREE SONS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2961
Mailing Address - Country:US
Mailing Address - Phone:205-824-9086
Mailing Address - Fax:
Practice Address - Street 1:146 THREE SONS DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-2961
Practice Address - Country:US
Practice Address - Phone:205-824-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT02361183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3201-0105-0766-335OtherPTCB