Organization
DESAK G HICKS
Active
Other names
Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DESAK GEORGE HICKS (OWNER/PHARMACIST)
(251) 276-3400
Entity
Organization
Contact information
Practice address
873 HIGHWAY 84, COFFEEVILLE, AL 36524-5012
(251) 276-3400
(251) 276-3562
Mailing address
873 HIGHWAY 84, COFFEEVILLE, AL 36524-5012
(251) 276-3400
(251) 276-3562
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
110452
AL
3336C0004X
Compounding Pharmacy
110452
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105672
NCPDP NUMBER
—
05
—
100001132
—
AL
Enumeration date
04/11/2006
Last updated
03/21/2011
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