Provider Demographics
NPI:1265038087
Name:HENDRICKSON, JUDITH ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:HENDRICKSON
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 1:400 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-1325
Mailing Address - Country:US
Mailing Address - Phone:732-716-1780
Mailing Address - Fax:
Practice Address - Street 1:400 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1325
Practice Address - Country:US
Practice Address - Phone:732-716-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01691200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist