Active NPI
Tyler Hicks, PHARMD
- Pharmacist
- Phoenix, AZ
National Provider Identifier
1518440387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S023524
- Practice address
- 4747 E Cactus Rd
Phoenix, AZ 85032-7725 - Phone
- (602) 404-3722
- NPI assigned
- Sep 7, 2018
- Sex
- Male
- 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 | S023524 | AZ | Primary |
Addresses
Primary practice location
4747 E Cactus Rd
Phoenix, AZ 85032-7725
Mailing address
3935 E Rough Rider Rd Unit 1126
Phoenix, AZ 85050-7354
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S023524 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart 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": "1536278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536278400000",
"number": "1518440387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3935 E ROUGH RIDER RD UNIT 1126",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850507354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4747 E CACTUS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850327725",
"telephone_number": "602-404-3722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "TYLER",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-07",
"last_updated": "2018-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S023524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.