Provider Demographics
NPI:1467625020
Name:HEDRICK, CARL K JR (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:K
Last Name:HEDRICK
Suffix:JR
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 1:303 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-1240
Mailing Address - Country:US
Mailing Address - Phone:304-457-4235
Mailing Address - Fax:304-457-6760
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-1240
Practice Address - Country:US
Practice Address - Phone:304-457-4235
Practice Address - Fax:304-457-6760
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist