Provider Demographics
NPI:1760886048
Name:HICKS, ASHLEY DANIELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:DANIELLE
Other - Last Name:FARGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:250 E SUPERIOR ST
Mailing Address - Street 2:15 PRENTICE PHARMACY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-472-3790
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:15 PRENTICE PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2968291835X0200X
WI16337-401835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology