Provider Demographics
NPI:1104109958
Name:HICKMAN, ANDREW THOMAS (BS PHARM)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:THOMAS
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1718
Mailing Address - Country:US
Mailing Address - Phone:513-523-4683
Mailing Address - Fax:513-523-4791
Practice Address - Street 1:200 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1718
Practice Address - Country:US
Practice Address - Phone:513-523-4683
Practice Address - Fax:513-523-4791
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120993183500000X
IN26017740A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist