Provider Demographics
NPI:1710381892
Name:HICKMAN, TAMIKO M (RPH)
Entity Type:Individual
Prefix:DR
First Name:TAMIKO
Middle Name:M
Last Name:HICKMAN
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 1:1225 STATE HIGHWAY 276
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-9376
Mailing Address - Country:US
Mailing Address - Phone:972-772-1609
Mailing Address - Fax:972-772-1606
Practice Address - Street 1:1225 STATE HIGHWAY 276
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9376
Practice Address - Country:US
Practice Address - Phone:972-772-1609
Practice Address - Fax:972-772-1606
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist