Provider Demographics
NPI:1164420220
Name:HENDRIX, DEMETRIA BARNES (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEMETRIA
Middle Name:BARNES
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 LONGLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-2825
Mailing Address - Country:US
Mailing Address - Phone:706-663-9002
Mailing Address - Fax:
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:AMBULATORY CARE PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-321-3779
Practice Address - Fax:706-321-3751
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist