Provider Demographics
NPI:1992816037
Name:HICKS GROUP INC
Entity type:Organization
Organization Name:HICKS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC CORP OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MC GILL HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-649-7437
Mailing Address - Street 1:1020 RICHLAND AVE W
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3224
Mailing Address - Country:US
Mailing Address - Phone:803-649-7437
Mailing Address - Fax:803-649-2062
Practice Address - Street 1:1020 RICHLAND AVE W
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3224
Practice Address - Country:US
Practice Address - Phone:803-649-7437
Practice Address - Fax:803-649-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
SC87783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2089699OtherPK
SC787781Medicaid
SC787781Medicaid