Provider Demographics
NPI:1730460940
Name:HICKMAN, WILLIAM WESLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WESLEY
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 FOXBOW CV
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9343
Mailing Address - Country:US
Mailing Address - Phone:910-274-3847
Mailing Address - Fax:
Practice Address - Street 1:4961 LONG BEACH RD SE STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8001
Practice Address - Country:US
Practice Address - Phone:910-457-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist