Provider Demographics
NPI:1548882889
Name:HICKS, JEREMIAH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
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 1:2304 LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1419
Mailing Address - Country:US
Mailing Address - Phone:302-399-4259
Mailing Address - Fax:
Practice Address - Street 1:4309 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2305
Practice Address - Country:US
Practice Address - Phone:202-966-3023
Practice Address - Fax:202-364-1202
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100001943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist