Provider Demographics
NPI:1669795449
Name:KICKER, JAMES WARREN JR (RPH (PHARMACIST))
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WARREN
Last Name:KICKER
Suffix:JR
Gender:M
Credentials:RPH (PHARMACIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BELTLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6545
Mailing Address - Country:US
Mailing Address - Phone:256-350-2572
Mailing Address - Fax:256-350-9175
Practice Address - Street 1:1101 BELTLINE ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6545
Practice Address - Country:US
Practice Address - Phone:256-350-2572
Practice Address - Fax:256-350-9175
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist