Provider Demographics
NPI:1417042011
Name:HICKMAN, LAURENCE ALLEN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:ALLEN
Last Name:HICKMAN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 LENAPE LANE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-8420
Mailing Address - Country:US
Mailing Address - Phone:717-762-7032
Mailing Address - Fax:
Practice Address - Street 1:307 EAST POTOMAC STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1203
Practice Address - Country:US
Practice Address - Phone:301-223-4100
Practice Address - Fax:301-223-6133
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist