Individual
BREANNA HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 GARTH BROOKS BLVD, YUKON, OK 73099-4107
(405) 350-0500
Mailing address
3501 GUNNISON RIVER DR, YUKON, OK 73099-3578
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15474
OK
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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