Active NPI
Jennifer M Hicks, PHARMD
- Pharmacist
- Moberly, MO
National Provider Identifier
1578844718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2011007381
- Practice address
- 1711 N Morley St
Moberly, MO 65270-3630 - Phone
- (660) 263-0793
- NPI assigned
- Sep 1, 2011
- Last updated
- Sep 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2011007381 | MO | Primary |
| Pharmacist | 183500000X | RPH025063 | GA |
Addresses
Primary practice location
1711 N Morley St
Moberly, MO 65270-3630
Mailing address
PO Box 762
Moberly, MO 65270-0762
Phone (912) 660-9976
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 |
|---|---|---|---|
| RPH025063 | GA | MD | Pharmacist |
| 2011007381 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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": "1314835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1578844718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 762",
"city": "MOBERLY",
"state": "MO",
"postal_code": "652700762",
"telephone_number": "912-660-9976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1711 N MORLEY ST",
"city": "MOBERLY",
"state": "MO",
"postal_code": "652703630",
"telephone_number": "660-263-0793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "JENNIFER",
"middle_name": "M",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-01",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2011007381",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH025063",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moberly, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.