Provider Demographics
NPI:1275133696
Name:HEDRICK, KIRSTEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22530 COUNTY ROAD 7630
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65550-9231
Mailing Address - Country:US
Mailing Address - Phone:573-330-8479
Mailing Address - Fax:
Practice Address - Street 1:1101 W HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-2368
Practice Address - Country:US
Practice Address - Phone:573-729-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014025410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist