Provider Demographics
NPI:1053016774
Name:HICKMAN, ELECIA RENEE (RPHT)
Entity type:Individual
Prefix:
First Name:ELECIA
Middle Name:RENEE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2911
Mailing Address - Country:US
Mailing Address - Phone:419-255-9524
Mailing Address - Fax:419-255-3177
Practice Address - Street 1:1525 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2911
Practice Address - Country:US
Practice Address - Phone:419-255-9524
Practice Address - Fax:419-255-3177
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09218473183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician