Provider Demographics
NPI:1669763207
Name:HICKEY, SEAN ROGER (RPH)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ROGER
Last Name:HICKEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHERRY RIVER PLZ
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-1371
Mailing Address - Country:US
Mailing Address - Phone:304-846-2406
Mailing Address - Fax:304-846-4517
Practice Address - Street 1:8 CHERRY RIVER PLZ
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1371
Practice Address - Country:US
Practice Address - Phone:304-846-2406
Practice Address - Fax:304-846-4517
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist