Amanda Hicks
Individual provider Active NPI Pharmacist · Atlantic, IA
NPI 1629348594 · NPPES record last updated Mar 18, 2016
Key facts
- NPI
- 1629348594
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 20681 (IA)
- Practice address
- 507 Chestnut St
Atlantic, IA 50022-1249 - Phone
- (712) 243-2125
- Fax
- (712) 243-2209
- NPI assigned
- Jan 9, 2012
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16628 | CO | MD | Pharmacist |
| 20681 | IA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20681 | IA | Yes |
| Pharmacist | 183500000X | 16628 | CO |
Addresses
Primary practice location
507 Chestnut St
Atlantic, IA 50022-1249
Mailing address
507 Chestnut St
Atlantic, IA 50022-1249
Phone (712) 243-2125
Other providers in Atlantic, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2016. 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.