Provider Demographics
NPI:1003121534
Name:HENDRICKS, CRAIG JOSEPH (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOSEPH
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3014
Mailing Address - Country:US
Mailing Address - Phone:570-406-0210
Mailing Address - Fax:
Practice Address - Street 1:657 HAMLIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:PA
Practice Address - Zip Code:18427
Practice Address - Country:US
Practice Address - Phone:570-689-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist