Provider Demographics
NPI:1295951523
Name:HICKS, JAMES KEVIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEVIN
Last Name:HICKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 GRANGER AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3824
Mailing Address - Country:US
Mailing Address - Phone:734-216-6204
Mailing Address - Fax:
Practice Address - Street 1:BUSCH'S PHARMACY
Practice Address - Street 2:565 E. MICHIGAN AVE
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176
Practice Address - Country:US
Practice Address - Phone:734-944-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist