Provider Demographics
NPI:1225514375
Name:FICKES, DANE M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANE
Middle Name:M
Last Name:FICKES
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 S CENTRAL AVE STE 101G
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7808
Mailing Address - Country:US
Mailing Address - Phone:541-329-0478
Mailing Address - Fax:541-314-9556
Practice Address - Street 1:724 S CENTRAL AVE STE 101G
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7808
Practice Address - Country:US
Practice Address - Phone:541-329-0478
Practice Address - Fax:541-314-9556
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00166591835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist