Provider Demographics
NPI:1255332284
Name:HENDRICKS, GUY (BCPS)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 HYACINTH AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-8061
Mailing Address - Country:US
Mailing Address - Phone:863-381-2156
Mailing Address - Fax:863-382-6838
Practice Address - Street 1:1073 HYACINTH AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-8061
Practice Address - Country:US
Practice Address - Phone:863-381-2156
Practice Address - Fax:863-382-6838
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL135051835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy