Provider Demographics
NPI:1124067640
Name:HICKS, CHRISTINE CAROLE (RPH)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CAROLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 SW BRABHAM WAY
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:OR
Mailing Address - Zip Code:97119-9025
Mailing Address - Country:US
Mailing Address - Phone:503-985-0140
Mailing Address - Fax:
Practice Address - Street 1:1152 BASELINE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-9019
Practice Address - Country:US
Practice Address - Phone:503-352-8553
Practice Address - Fax:503-352-8554
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009911183500000X
WAPH00017057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00017057OtherPHARMACIST LICENSE
ORRPH-0009911OtherPHARMACIST LICENSE