Provider Demographics
NPI:1568846525
Name:HICKMAN, LAUREN DEANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DEANNA
Last Name:HICKMAN
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 1:1900 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3913
Mailing Address - Country:US
Mailing Address - Phone:844-590-6351
Mailing Address - Fax:
Practice Address - Street 1:600 N. WOLFE STREET
Practice Address - Street 2:CARNEGIE 180
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-502-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25048183500000X
NC25068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist