Provider Demographics
NPI:1942582879
Name:HICKLIN, KIA CATOE
Entity Type:Individual
Prefix:DR
First Name:KIA
Middle Name:CATOE
Last Name:HICKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 TIMBER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-6148
Mailing Address - Country:US
Mailing Address - Phone:803-324-5306
Mailing Address - Fax:
Practice Address - Street 1:1237 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2353
Practice Address - Country:US
Practice Address - Phone:803-939-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist