Provider Demographics
NPI:1760085500
Name:HICKS, RICHARD M
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E TARPON AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5438
Mailing Address - Country:US
Mailing Address - Phone:727-937-4203
Mailing Address - Fax:
Practice Address - Street 1:1000 E TARPON AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5438
Practice Address - Country:US
Practice Address - Phone:727-937-4203
Practice Address - Fax:727-942-7687
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PS24882OtherFLORIDA PHARMACIST LICENSE NUMBER