Active NPI
Desak G Hicks, RPH
- Durable Medical Equipment & Medical Supplies
- Coffeeville, AL
National Provider Identifier
1396981312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Practice address
- 873 Highway 84
Coffeeville, AL 36524-5012 - Phone
- (251) 276-3400
- Fax
- (251) 276-3562
- NPI assigned
- Dec 22, 2008
- Last updated
- Mar 21, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary | ||
| Pharmacist | 183500000X | 11671 | AL | |
| Community/Retail Pharmacy | 3336C0003X | 113345 | AL |
Addresses
Primary practice location
873 Highway 84
Coffeeville, AL 36524-5012
Mailing address
873 Highway 84
Coffeeville, AL 36524-5012
Phone (251) 276-3400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009501290 | Medicaid | AL |
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11671 | AL | MD | Pharmacist |
| 113345 | AL | MD | Community/Retail Pharmacy |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frisco City Pharmacy, LLC | Community/Retail Pharmacy | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Frisco City, AL
- NPI 1124359286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300665600000",
"number": "1396981312",
"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": {
"last_name": "HICKS",
"first_name": "DESAK",
"middle_name": "G",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-22",
"last_updated": "2011-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "11671",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "AL",
"license": "113345",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "009501290",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coffeeville, AL
Sources for this page
- 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.