Provider Demographics
NPI:1972609980
Name:HICKEY, TERESA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:HICKEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BETA CT N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7807
Mailing Address - Country:US
Mailing Address - Phone:561-358-4124
Mailing Address - Fax:561-582-5056
Practice Address - Street 1:5300 EAST AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2387
Practice Address - Country:US
Practice Address - Phone:561-227-5153
Practice Address - Fax:561-845-7993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist