Provider Demographics
NPI:1447434030
Name:HICKS, BROOKE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 KIRKLEVINGTON DR APT 234
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2492
Mailing Address - Country:US
Mailing Address - Phone:859-806-0310
Mailing Address - Fax:859-373-0841
Practice Address - Street 1:1808 ALEXANDRIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3114
Practice Address - Country:US
Practice Address - Phone:859-373-0841
Practice Address - Fax:859-373-0841
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist