Provider Demographics
NPI:1780625897
Name:HICKS, III, JAMES L (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:HICKS, III
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 1:418 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1724
Mailing Address - Country:US
Mailing Address - Phone:601-428-0688
Mailing Address - Fax:601-428-0689
Practice Address - Street 1:3160 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1926
Practice Address - Country:US
Practice Address - Phone:601-428-0688
Practice Address - Fax:601-428-0689
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist