Provider Demographics
NPI:1801677117
Name:RICKS, DAMON JEROME JR (RPH)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:JEROME
Last Name:RICKS
Suffix:JR
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 1:3316 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2302
Mailing Address - Country:US
Mailing Address - Phone:202-232-1455
Mailing Address - Fax:202-232-1453
Practice Address - Street 1:3316 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2302
Practice Address - Country:US
Practice Address - Phone:202-232-1455
Practice Address - Fax:202-232-1453
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH200004821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist