| Organization Name: | DESAK G HICKS |
| NPI Number: | 1134182827 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DESAK GEORGE HICKS (OWNER/PHARMACIST) |
| Mailing Address: | 873 Highway 84 Coffeeville |
| State: | AL US |
| Postal Code: | 365245012 |
| Phone Number: | 2512763400 |
| Fax Number: | 2512763562 |
| NPI Enumeration Date: | 04/11/2006 |
| NPI Last Update Date: | 03/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | 110452 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |