Provider Demographics
NPI:1477986701
Name:HENDRICKSON, GREGORY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7929 E GAZELLE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-7833
Mailing Address - Country:US
Mailing Address - Phone:928-778-5609
Mailing Address - Fax:
Practice Address - Street 1:1310 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1492
Practice Address - Country:US
Practice Address - Phone:928-277-9965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist