NPIMap

Individual provider Active NPI

Jerry L. Hicks Sr., RPH

  • Pharmacist
  • Kent, WA
National Provider Identifier
1518223056
Registry record updated Apr 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH00009801 Issued in WA
Practice address
10201 SE 240TH St
Kent, WA 98031-4895
Phone
(253) 859-5533
Fax
(253) 859-5541
NPI assigned
Apr 10, 2012
Last updated
Apr 10, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH00009801 WA Primary

Addresses

Primary practice location

10201 SE 240TH St
Kent, WA 98031-4895

Mailing address

10201 SE 240TH St
Kent, WA 98031-4895
Phone (253) 859-5533

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

LicenseStateTypeSpecialty
PH00009801WAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Fred Meyer Stores Inc. Past Accepting new patients
Fred Meyer Stores Inc Past 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.

NPI Registry JSON

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1518223056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 SE 240TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314895",
            "telephone_number": "253-859-5533",
            "fax_number": "253-859-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 SE 240TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980314895",
            "telephone_number": "253-859-5533",
            "fax_number": "253-859-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "JERRY",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00009801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.