Provider Demographics
NPI:1699057513
Name:HICKS, GREGORY (PHARMD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 HIGH ST W
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-4505
Mailing Address - Country:US
Mailing Address - Phone:757-686-5929
Mailing Address - Fax:757-686-8503
Practice Address - Street 1:5917 HIGH ST W
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-4505
Practice Address - Country:US
Practice Address - Phone:757-686-5929
Practice Address - Fax:757-686-8503
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist