Tina Hicov, RPH
Individual provider Active NPI Pharmacist · Avon Lake, OH
NPI 1285916239 · NPPES record last updated Sep 15, 2011
Key facts
- NPI
- 1285916239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 03122256 (OH)
- Practice address
- 32798 Walker Rd
Avon Lake, OH 44012-1443 - Phone
- (440) 930-5873
- NPI assigned
- Sep 15, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03122256 | OH | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03122256 | OH | Yes |
Addresses
Primary practice location
32798 Walker Rd
Avon Lake, OH 44012-1443
Mailing address
32798 Walker Rd
Avon Lake, OH 44012-1443
Phone (440) 930-5873
Other providers in Avon Lake, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.