Provider Demographics
NPI:1134405954
Name:BAKER HICKERSON, CHRISTINA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BAKER HICKERSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 WISEMAN BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4422
Mailing Address - Country:US
Mailing Address - Phone:210-441-4501
Mailing Address - Fax:210-441-4502
Practice Address - Street 1:3903 WISEMAN BLVD STE 313
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4422
Practice Address - Country:US
Practice Address - Phone:210-441-4501
Practice Address - Fax:104-414-5022
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist