Provider Demographics
NPI:1528374733
Name:HICKOX, LETIZIA S (RPH)
Entity Type:Individual
Prefix:
First Name:LETIZIA
Middle Name:S
Last Name:HICKOX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7386
Mailing Address - Country:US
Mailing Address - Phone:856-691-0238
Mailing Address - Fax:
Practice Address - Street 1:52 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2831
Practice Address - Country:US
Practice Address - Phone:856-455-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1989600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist