Active NPI
Jodi Lynn Hicks I
- Pharmacist
- Goshen, IN
National Provider Identifier
1124476130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26017560A
- Practice address
- 4522 Elkhart Rd
Goshen, IN 46526-5822 - Phone
- (574) 875-3010
- Fax
- (574) 875-3065
- NPI assigned
- May 31, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26017560A | IN | Primary |
Addresses
Primary practice location
4522 Elkhart Rd
Goshen, IN 46526-5822
Mailing address
4522 Elkhart Rd
Goshen, IN 46526-5822
Phone (574) 875-3010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26017560A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1124476130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4522 ELKHART RD",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465265822",
"telephone_number": "574-875-3010",
"fax_number": "574-875-3065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4522 ELKHART RD",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465265822",
"telephone_number": "574-875-3010",
"fax_number": "574-875-3065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "JODI",
"middle_name": "LYNN",
"name_suffix": "I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-31",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26017560A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.