Desak G Hicks

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

110452 Issued in AL

Legal business name

DESAK G HICKS

Doing business as

Village Pharmacy

Practice address

873 Highway 84
Coffeeville, AL 36524-5012

Phone

(251) 276-3400

Fax

(251) 276-3562

NPI assigned

Apr 11, 2006

Last updated

Mar 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Desak George HicksNPI 1396981312

Title

Owner/Pharmacist

Phone

(251) 276-3400

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Village Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Desak G Hicks, RPH

  • Durable Medical Equipment & Medical Supplies
  • Coffeeville, AL
  • NPI 1396981312
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1134182827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "873 HIGHWAY 84",
            "city": "COFFEEVILLE",
            "state": "AL",
            "postal_code": "365245012",
            "telephone_number": "251-276-3400",
            "fax_number": "251-276-3562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "873 HIGHWAY 84",
            "city": "COFFEEVILLE",
            "state": "AL",
            "postal_code": "365245012",
            "telephone_number": "251-276-3400",
            "fax_number": "251-276-3562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESAK G HICKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "DESAK",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "251-276-3400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "110452",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "AL",
            "license": "110452",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "0105672",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001132",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Desak G Hicks, RPH
• West Bend/Bethel Volunteer Fire Department

• Community/Retail Pharmacy in Coffeeville, AL
• Providers in Coffeeville, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.