Provider Demographics
NPI:1033217427
Name:HENDRICK, KEVIN L (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:HENDRICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5183
Mailing Address - Country:US
Mailing Address - Phone:618-451-7665
Mailing Address - Fax:618-254-1772
Practice Address - Street 1:600 E FERGUSON AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-2146
Practice Address - Country:US
Practice Address - Phone:618-254-6223
Practice Address - Fax:618-254-1772
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist