Provider Demographics
NPI:1518163336
Name:HICKS, JENNIFER PONDER (PHARM D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PONDER
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29812 AL HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AL
Mailing Address - Zip Code:35958-5240
Mailing Address - Country:US
Mailing Address - Phone:256-597-4020
Mailing Address - Fax:256-597-4077
Practice Address - Street 1:29812 AL HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AL
Practice Address - Zip Code:35958-5240
Practice Address - Country:US
Practice Address - Phone:256-597-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist