Provider Demographics
NPI:1750941167
Name:SWEET, DESIRAE CHRISTAN HICKMAN (PHARMACIST (PHARMD))
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:CHRISTAN HICKMAN
Last Name:SWEET
Suffix:
Gender:F
Credentials:PHARMACIST (PHARMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MCCLELLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4373
Mailing Address - Country:US
Mailing Address - Phone:417-347-6337
Mailing Address - Fax:417-347-6336
Practice Address - Street 1:3201 MCCLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4373
Practice Address - Country:US
Practice Address - Phone:417-347-6337
Practice Address - Fax:417-347-6336
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016027169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist