Provider Demographics
NPI:1487183877
Name:HICKEY, ROBERT WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WALTER
Last Name:HICKEY
Suffix:
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 1:115 SHEPPARD LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2601
Mailing Address - Country:US
Mailing Address - Phone:631-681-2936
Mailing Address - Fax:
Practice Address - Street 1:115 SHEPPARD LN
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767
Practice Address - Country:US
Practice Address - Phone:631-681-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist