Provider Demographics
NPI:1366176893
Name:HICKMANN, EMMA MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MAE
Last Name:HICKMANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:MAE
Other - Last Name:DREISCHMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7718 RADCLIFFE DR APT A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2085
Mailing Address - Country:US
Mailing Address - Phone:608-225-7468
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21306-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist