Individual
JOHNNY MIKE HICKS II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3081 N HIGHWAY 112, FAYETTEVILLE, AR 72704-7436
(479) 587-1853
Mailing address
3081 N HIGHWAY 112, FAYETTEVILLE, AR 72704-7436
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD11945
AR
Other
Enumeration date
10/29/2020
Last updated
10/29/2020
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