Provider Demographics
NPI:1518567197
Name:FICKEN, CAROLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:
Last Name:FICKEN
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 1:5908 NW 78TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4429
Mailing Address - Country:US
Mailing Address - Phone:816-916-6507
Mailing Address - Fax:
Practice Address - Street 1:908 WALTON WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2193
Practice Address - Country:US
Practice Address - Phone:816-776-8577
Practice Address - Fax:816-776-8764
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist